早期活动对慢性阻塞性肺疾病有创机械通气继发急性胃肠损伤患者危险因素影响的临床研究  

A clinical study on the effect of early activities on risk factors of acute gastrointestinal injury in patients with chronic obstructive pulmonary disease induced by mechanical ventilation

作　　者：刘景刚[1] 张珂[1] 袁继印 杨文宝[1] 刘继华[1] 杨圣强[1] Liu Jinggang;Zhang Ke;Yuan Jiyin;Yang Wenbao;Liu Jihua;Yang Shengqiang(Department of Intensive Care Unit,Affiliated Huxi Hospital of Jining Medical College ( Shanxian Central Hospital),Shanxian 274300,China)

机构地区：[1]济宁医学院附属湖西医院(单县中心医院)重症医学科,274300

出　　处：《中国医师杂志》2019年第2期207-211,共5页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(2015WS0467)~~

摘　　要：目的探讨早期活动对慢性阻塞性肺疾病(COPD)有创机械通气继发急性胃肠损伤(AGI)患者危险因素的影响。方法选择2017年8月至2018年4月本院重症医学科收治的118例COPD非糖尿病机械通气患者为研究对象,根据是否存在AGI分为AGI组71例和非AGI组47例。采集患者前降钙素原(PCT)、D-乳酸、血清白蛋白(ALB)、空腹血糖(FPG)、空腹胰岛素(FINS)检查数据,计算急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),采用稳态模型胰岛素抵抗指数(HOMA-IR)评价受试者胰岛素抵抗情况。Logistics回归分析筛选影响AGI的危险因素。对AGI患者按照随机数字表法分为治疗组36例和对照组35例。在相同常规治疗的基础上,治疗组同时给予早期活动。观察两组患者治疗前以及治疗后3 d的PCT、D-乳酸、FPG、HOMA-IR、APACHEⅡ评分和AGI分级构成的差异。结果 AGI组患者PCT、D-乳酸、FPG、HOMA-IR、APACHEⅡ评分高于非AGI组[(2. 72±0. 54) ng/ml vs (1. 81±0. 62) ng/ml;(17. 43±2. 63) mg/ml vs (13. 61±1. 6) mg/ml;(10. 1±1. 0) mmol/L vs (8. 4±0. 9) mmol/L;(2. 4±0. 5) vs (1. 7±0. 4);(23. 8±2. 9)分vs (21. 7±4. 3)分],ALB低于非AGI组[(29. 1±2. 2) g/L vs (30. 6±3. 2) g/L],差异有统计学意义(P <0. 05)。多因素logistic回归分析显示,PCT、D-乳酸、FPG、HOMA-IR、APACHEⅡ评分是COPD有创机械通气患者发生AGI的危险因素(回归系数分别为4. 337、1. 226、5. 106、4. 469、0. 584,P <0. 05)。治疗前治疗组与对照组的PCT、D-乳酸、FPG、HOMA-IR、APACHEⅡ评分差异无统计学意义(P> 0. 05)。治疗后治疗组PCT、D-乳酸、FPG、HOMA-IR、APACHEⅡ评分明显低于对照组[(2. 00±0. 49) ng/ml vs (2. 34±0. 34) ng/ml;(15. 38±1. 71) mg/ml vs (17. 38±2. 88) mg/ml;(8. 9±0. 9) mmol/L vs (9. 6±0. 7)mmol/L;(1. 9±0. 4) vs (2. 2±0. 4);(21. 0±1. 8)分vs (22. 2±2. 7)分],且AGI严重程度降低(治疗组0、Ⅰ、Ⅱ、Ⅲ和Ⅳ级患者分别为8、18、6、3例和1例,对照组分别为4、12、9�Objective To investigate the effect of early activities on risk factors of acute gastrointestinal injury (AGI) in patients with chronic obstructive pulmonary disease (COPD) induced by mechanical ventilation. Methods A total of 118 mechanically ventilated non-diabetic patients with chronic obstructive pulmonary disease who were admitted to our hospital from August 2017 to April 2018 were enrolled in the study. The patients were divided into AGI group (71 cases) and non-AGI group (47 cases) according to the presence or absence of AGI. The examined data were collected in the patients prospectively such as preprocalcitonin (PCT), D-lactic acid, serum albumin (ALB), fasting plasma glucose (FPG), fasting insulin (FINS), and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores were calculated. The homeostasis model insulin resistance index was used (HOMA-IR) to assess the subjects′ insulin resistance. Logistics regression analysis screened for risk factors that affected patients' AGI. The AGI patients were divided into treatment group (36 cases) and control group (35 cases) according to the random number table method. On the basis of the same conventional treatment, the treatment group were received early mobilization. The differences of PCT, D-lactate, FPG, HOMA-IR, APACHE Ⅱ scores, and AGI grades before and after treatment for 3 days were observed for both groups of patients. Results The PCT, D-lactate, FPG, HOMA-IR, and APACHE Ⅱ scores were higher in the AGI group than in the non-AGI group [(2.72±0.54)ng/ml vs (1.81±0.62)ng/ml;(17.43±2.63)mg/ml vs (13.61±1.6)mg/ml;(10.1±1.0)mmol/L vs (8.4±0.9)mmol/L;(2.4±0.5) vs (1.7±0.4);(23.8±2.9)point vs (21.7±4.3)point], and the ALB were lower than non-AGI group [(29.1±2.2)g/L vs (30.6±3.2)g/L], with statistically significant difference (P<0.05). Multivariate logistic regression analysis showed that PCT, D-lactic acid, FPG, HOMA-IR, and APACHE Ⅱ scores were risk factors for AGI in mechanically ventilated non-diabetic patients with COPD (regres

关 键 词：肺疾病 慢性阻塞性 通气机 机械 胃肠疾病 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统]