肠内免疫营养治疗在慢性阻塞性肺疾病急性发作患者中的临床应用  

Clinical use of enteral immune nutrition in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：张志成[1] 邹剑峰[1] 

机构地区：[1]海军总医院重症医学科,北京100048

出　　处：《解放军医学杂志》2015年第5期411-414,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨应用肠内免疫营养制剂对于慢性阻塞性肺疾病急性加重(A ECO P D)患者营养状况的改善效果及对免疫和急性炎性反应的影响。方法纳入2013年1月-2014年6月在海军总医院ICU住院且需行机械通气的AECOPD患者62例,随机分为免疫营养组(n=32,给予瑞能)和对照组(n=30,给予本院营养科自制匀浆膳)。两组使用等热量肠内营养,营养素经鼻肠管给予。入院当天及第14、18天抽取静脉血,检测血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平,同时在床旁测上臂肌围(UAMC),比较两组14d脱机率及28d内的机械通气时间。结果免疫营养组患者14d脱机率明显高于对照组,28d内机械通气时间少于对照组(P<0.05);PA、TFN及UAMC等营养指标明显高于对照组(P<0.05),IL-6、CRP、TNF-α等免疫指标明显低于对照组(P<0.05)。结论 AECOPD患者应用免疫肠内营养支持较匀浆膳能更好地改善患者的营养状态、免疫功能,并可下调急性炎症反应水平,提高早期撤机成功率,是一种更为合适的营养支持方法。Objective To investigate the use of enteral immune nutrition preparation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）, regard its efficacy in improving nutritional status, and its influence on immunity and the status of acute inflammator y reaction of the patients. Methods Sixty-two AECOPD patients requiring mechanical ventilation in ICU of our hospital were randomly divided into two groups： immune nutrition group [study group, n=32, receiving Ruineng（a product of Huarui Pharmaceutical Ltd.）, which contained essential fatty acids, Omega-3 fatty acids, and energy 1.3 kcal/ml] and conventional nutrition group（control group, n=30, receiving the hospital self-made homogenized diet with 1.2 kal/ml）. Patients in the two groups took enteral nutrition of equal calorie, and it was given by nasointestinal tube. On the day of admission and the 14 th and 18 th after admission, venous blood was obtained for the determination of serum albumin, prealbumin, transferrin, C reactive protein（CRP）, tumor necrosis factor-α（TNF-α）, and interleukin-6（IL-6）. At the same time upper arm muscle circumference（MAMC） was measured at the bed side. The 14-day off-respirator rate and mechanical ventilation time within 28 days were compared between the two groups. Results The 14-day off-respirator rate was higher in study group than in control group（P〈0.05）, and the mechanical ventilation time within 28 days was less in study group than in control group（P〈0.05）. The pre-albumin, transferrin, and upper arm muscle circumference were higher in study group compared with those in control group（P〈0.05）; IL-6, CRP, TNF-α levels of study group were lower than those of the control group（P〉0.05）. Conclusions Compared with homogenized diet, immune enteral nutrition could better improve the nutritional status and immune function, lower the acute inflammatory response level, increase the success rate of early off-respirator in AECOPD patients, therefore, enteral i

关 键 词：肺疾病 慢性阻塞性 营养支持 呼吸 人工 

分 类 号：R563.9[医药卫生—呼吸系统]