早期肠内营养支持联合无创双水平气道正压通气对COPD合并呼吸衰竭患者预后的影响  

Effect of Early Enteral Nutrition Support Combined with Noninvasive Bi-level Positive Airway Pressure on Prognosis of Patients with COPD Complicated with Respiratory Failure

作　　者：夏万昱 艾辉[2] 韩若东 XIA Wanyu;AI Hui;HAN Ruodong(Department of Emergency,the People′s Hospital of Bozhou,Bozhou 236800,China;Department of Critical Medicine,the People′s Hospital of Bozhou,Bozhou 236800,China)

机构地区：[1]亳州市人民医院急诊科,安徽亳州236800 [2]亳州市人民医院重症医学科,安徽亳州236800

出　　处：《医学综述》2022年第11期2283-2288,共6页Medical Recapitulate

摘　　要：目的探讨早期肠内营养支持联合无创双水平气道正压通气对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者预后的影响。方法选取2018年2月至2021年2月亳州市人民医院收治的100例COPD合并发呼吸衰竭患者作为研究对象,按照治疗方法不同分为对照组和试验组,各50例。两组均给予常规基础治疗,其中对照组在此基础上给予无创双水平气道正压通气治疗,试验组在对照组的基础上给予早期肠内营养支持,均连续治疗10 d。观察并比较两组患者的营养指标(白蛋白、总蛋白、转铁蛋白、前白蛋白)、肺功能指标[第一秒用力呼气量(FEV_(1))、呼气流量峰值(PEF)]和免疫指标[免疫球蛋白(Ig)A、IgG、CD4^(+)、CD4^(+)/CD8^(+)]变化,及预后[临床症状消失时间、呼吸功能恢复时间、重症监护病房(ICU)住院时间、住院时间]和不良反应发生情况。结果不同时点间、组间白蛋白、总蛋白、转铁蛋白、前白蛋白水平的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。治疗后,两组患者的白蛋白、总蛋白、转铁蛋白、前白蛋白水平均升高,且试验组高于对照组(P<0.05)。不同时点间、组间FEV_(1)、PEF的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。治疗后,两组患者的FEV_(1)、PEF均升高,且试验组高于对照组(P<0.05)。不同时点间、组间IgA、IgG、CD4^(+)、CD4^(+)/CD8^(+)水平的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。治疗后,两组患者的IgA、IgG、CD4^(+)、CD4^(+)/CD8^(+)水平均升高,且试验组高于对照组(P<0.05)。试验组的临床症状消失时间、呼吸功能恢复时间、ICU住院时间、住院时间均短于对照组(均P<0.01)。试验组与对照组的总不良反应发生率比较差异无统计学意义[6.00%(3/50)比8.00%(4/50)](P>0.05)。结论早期肠内营养支持联合无创双水平气道正压通气更有�Objective To investigate the effect of early enteral nutrition support combined with noninvasive bi-level positive airway pressure(BiPAP)on the prognosis of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 100 patients with COPD complicated with respiratory failure admitted to the People′s Hospital of Bozhou from Feb.2018 to Feb.2021 were included,and divided into a control group and a test group according to different treatment methods,with 50 cases in each group.Both groups were given routine basic treatment,and the control group was given noninvasive BiPAP on this basis,while the test group was given early enteral nutrition support on the basis of the control group,for 10 d continuously.The changes of nutritional indicators(albumin,total protein,transferrin,prealbumin),pulmonary function indexes[forced expiratory volume in first second(FEV_(1)),peak expiratory flow(PEF)]and immune indicators[immunoglobulin(Ig)A,IgG,CD4^(+),CD4^(+)/CD8^(+)]were observed and compared between the two groups,as well as prognosis[disappearance time of clinical symptoms,recovery time of respiratory function,length of stay in intensive care unit(ICU),length of hospital stay]and occurrence of adverse reactions.Results The main effects of albumin,total protein,transferrin,and prealbumin levels between different time points and groups were statistically significantly different(P<0.01),and there were interactions between time points and groups(P<0.01).After treatment,the levels of albumin,total protein,transferrin and prealbumin in both groups were increased,and the test group was higher than the control group(P<0.05).There were significant differences in the main effects of FEV_(1) and PEF between different time points and groups(P<0.01),and there were interactions between time points and groups(P<0.01).After treatment,the levels of FEV_(1) and PEF in both groups were increased,and the test group was higher than the control group(P<0.05).There were significant differences

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 早期肠内营养支持 无创双水平气道正压通气 

分 类 号：R563[医药卫生—呼吸系统]