不同营养支持对机械通气COPD呼吸衰竭患者免疫功能的影响及疗效观察

目的探讨肠内营养或肠外营养对机械通气COPD呼吸衰竭患者免疫功能的影响及治疗效果。方法54例患者随机分为肠内营养组和肠外营养组,各27例。两组患者均在营养支持前及营养支持10d后,观察体质量变化百分比(IBW%)、肱三头肌皮褶厚度(TSF)、总蛋白、血清白蛋白,血红蛋白;总淋巴细胞计数(TLC)、IgG、IgM、IgA、CD_3、CD_4、CD_8、CD_4/CD_8;治疗前后PaO_2与PaCO_2变化、感染持续时间、机械通气时间、ICU住院治疗时间。结果两组病例治疗后IBW%、TSF、血清总蛋白、血清白蛋白、血红蛋白与治疗前相比明显增高,EN组IBW%、TSF优于PN组(P<0.05或P<0.01);两组患者TLC、CD_3、CD_4、CD_4/CD_8均较治疗前明显增高,治疗后EN组TLC、CD_4、CD_4/CD_8高于PN组(P<0.05或P<0.01);两组患者PaO_2、PaCO_2均较治疗前明显改善,且EN组优于TPN组,机械通气10d内EN组感染持续时间、机械通气时间、ICU住院时间明显低于PN组,差异有统计学意义(P<0.05或P<0.01)。结论肠内营养及肠外营养均能改善机械通气COPD呼吸衰竭患者的营养状态及免疫功能,肠内营养在临床疗效上优于肠外营养。

The Effects of Immune Functions and Therapeutic Effects of Enteral and Parenteral Nu-tritional Support in Treating COPD Patients with Respiratory Failure

Objective To investigate the effects of enteral and paparenteral nutritional support using mechanical ventilation(MV)in treating COPD patients with respiratory failure.Methods 54 mechanical-ventilation-use patients were randomly divided into two groups:early enteral nutrition group(EN)and early total parenteral nutrition group(TPN) .The same amount of energy and nitrogen was given to the two groups. The two groups were compared on IBW%,TSF, TP, SAP, Hb,TLC, CD_3, CD_4, CD_4/CD_8, PaO_2, PaCO_2, infection time, mechanical ventilation time and RICU stay time in I0 days. Results IBW%,TSF,TP, SAP, Hb,ILC,CD_3,CD_4,CD_4/CD_8,PaO_2 and PaCO_2 were both improved significiantly in two groups (P<0.01). IBW% ,TSF,TLC ,CD_4,CD_4CD_8,immunity infection time,mechanical ventilation time and RICU stay time in EN group were significiantly improved compared with those of PN group(P<0.05).Conclusions In treating COPD patients with acute respiratory failure, EN seemed to be safer and more effective than PN support while using MV in terms of improving nutrition , immunity and therapeutic effects.