泵入与顿服肠内营养对AECOPD合并Ⅱ型呼吸衰竭机械通气患者的疗效研究  

Efficacy of pumping and meal served enteral nutrition in patients with AECOPD combined with typeⅡrespiratory failure and mechanical ventilation

作　　者：冯丽伟[1] 付丽[2] 魏立娜[1] 张清照[1] 刘华宇 晏东波 FENG Li-wei;FU Li;WEI Li-Na;ZHANG Qing-zhao;LIU Hua-yu;YAN Dong-bo(Department of Intensive Care Unit,The Second Hospital,Tianjin Medical University,Tianjin 300211,China;Department of Nursing,The Second Hospital,Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院重症医学科,天津300211 [2]天津医科大学第二医院护理部,天津300211

出　　处：《天津医科大学学报》2022年第6期631-635,共5页Journal of Tianjin Medical University

基　　金：天津医科大学第二医院青年科研基金(2020ydey24)。

摘　　要：目的:探讨泵入与顿服肠内营养支持对慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的机械通气患者的疗效。方法:选取天津医科大学第二医院重症医学科2020年12月—2021年12月收治的接受肠内营养支持的AECOPD合并Ⅱ型呼吸衰竭的机械通气患者为研究对象。采用病例对照随机数字法将患者随机分为顿服组(66例)与泵入组(64例)。顿服组每日4次自鼻胃管推注肠内营养液,泵入组采用营养泵持续泵入肠内营养液;比较两组患者治疗前、后的营养状态、感染情况、肝肾功能等各项指标;两组机械通气时间、ICU住院时间、总住院时间有无差异。结果:治疗后两组营养状态,指标白蛋白、血红蛋白、总蛋白、营养筛查评分(NRS-2002)差异无统计学意义(均P>0.05)。感染指标PCT、白细胞、中性粒细胞百分比、CRP、淋巴细胞百分比、淋巴细胞计数差异无统计学意义(均P>0.05)。肝肾功能指标谷草转氨酶、谷丙转氨酶、肌酐值(Z=-1.155、-0.544、0.073,均P>0.05),差异无统计学意义。两组机械通气时间、ICU住院时间、总住院时间差异无统计学意义(Z=-0.641、-0.209、-0.721,均P>0.05)。与治疗前比顿服组营养指标均降低,泵入组重要指标均升高;与治疗前相比,两组治疗后感染指标均有改善,但肝肾功能指标未见显著变化。结论:对于慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的机械通气患者,泵入营养支持患者部分营养指标有增高趋势。两种方式对营养、感染、肝肾功能未见显著差异。临床治疗可根据危重患者实际情况选择恰当的营养支持方式。Objective:To investigate the effect of enteral nutrition supported by pump and meal served on mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with typeⅡrespiratory failure.Methods:Mechanical ventilation patients with AECOPD and typeⅡrespiratory failure who received enteral nutrition support from December 2020 to December 2021 in the Department of Intensive Care Unit,The Second Hospital of Tianjin Medical University were selected.Using case-control random number method,the patients were randomly divided into the meal served group(66 cases)and the pumping group(64 cases).Meal served group received enteral nutrition solution through nasogastric tube 4 times a day.The pumping group recieved enteral nutrient solution by a nutrient pump to continuously pump Nutritional status,infection status,liver and kidney function before and after treatment;duration of mechanical ventilation,length of ICU stay and total length of hospital stay were compared between the two groups.Results:After treatment,there was no significant difference in nutritional status between the two groups,and there was no significant difference in albumin,hemoglobin,total protein and nutritional screening score(NRS-2002)between the two groups(all P>0.05).There were no significant differences in PCT,white blood cells,percentage of neutrophils,CRP,percentage of lymphocytes and lymphocyte count(all P>0.05).There was no significant difference in liver and kidney function,and the indexes were aspartate aminotransferase,alanine aminotransferase and creatinine(Z=-1.155,-0.544,0.073;all P>0.05).There was no significant difference in the duration of mechanical ventilation,length of ICU stay,and total length of hospital stay between the two groups(Z=-0.641,-0.209,-0.721;all P>0.05).Compared with the pre-treatment group,nutritional indicators decreased in the meal served group;the important indexes of the pumping group increased.The indicators of infection were improved compared with those b

关 键 词：肠内营养 机械通气 慢性阻塞性肺疾病 

分 类 号：R563.8[医药卫生—呼吸系统]