肠内营养时机对慢性阻塞性肺疾病急性加重期机械通气患者疗效和预后的影响

目的 探讨肠内营养时机对慢性阻塞性肺疾病急性加重期机械通气患者疗效和预后的影响。方法 选取2017年1月～2018年12月我院重症医学科收治的AECOPD机械通气患者共102例,根据肠内营养时机的不同,分为早期组(52例,入ICU 1～2 d内开通)和晚期组(50例,入ICU≥7 d开通),两组患者均采用代谢车(间接量热法)测定每天的基础能量消耗(BEE),并根据测量值,在开通肠内营养3～5 d内达到营养需要量,治疗期间,测量患者治疗前及治疗7 d、14 d的各项指标:感染及炎症指标[PCT(前降钙素)、IL-6(白介素6)、IL-8(白介素8)],营养指标[PA(前白蛋白)、ALB(白蛋白)、TP(血清总蛋白)],相关评分[APACHEⅡ、全身炎症反应综合征评分(SIRS)和多器官功能障碍(MODS)评分],以及预后指标:机械通气时间、MODS发生率、ICU住院时间。结果 两组治疗前营养指标、危重症评分表、感染及炎症指标比较无统计学差异。与治疗前相比,早期组PCT、IL-6、IL-8明显下降;晚期组PCT较治疗前降低,IL-6、IL-8与治疗前比较无明显差异;两组各评分表数值均较治疗前显著下降,但两组间比较无统计学差异。与晚期组相比较,早期组PCT、IL-6、IL-8均较晚期组明显下降,差异均有统计学意义;早期组机械通气时间、ICU住院时间均明显缩短,MODS发生率明显下降。开通肠内营养7 d时,早期组PA值高于晚期组(P0.05),两组ALB、TP水平均低于治疗前,差异均有统计学意义(P0.05);而在第14天时,早期组PA、ALB和TP均显著高于晚期组,差异有统计学意义(P0.05)。结论 早期合理开通肠内营养治疗,有助于改善患者营养状况,抑制炎症反应,缩短机械通气时间及ICU住院时间,进而提高AECOPD机械通气患者的临床疗效及预后。

Effect of enteral nutrition timing on the efficacy and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation

Objective To investigate the effect of enteral nutrition timing on the efficacy and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation.Methods A total of 102 patients with AECOPD mechanical ventilation who were admitted to the Department of Critical Care Medicine in our hospital from January 2017 to December 2018 were selected.According to different timing of enteral nutrition,the patients were divided into early group (52 cases,given enteral nutrition within 1-2 days upon admission to ICU) and late group (50 cases,given enteral nutrition within 7 days upon admission to ICU).Metabolic cart (indirect calorimetry) was used to determine the baseline energy expenditure (BEE) per day in both groups.According to the measured value,the required amount of nutrition was reached within 3-5 days of implementing the enteral nutrition.During the treatment period,the indicators of the patients before treatment and 7 days and 14 days after treatment were measured:infection and inflammation indicators [PCT (pre-calcitonin),IL-6 (interleukin-6),IL-8 (interleukin-8)],nutritional indicators [PA (pre-albumin),ALB (albumin),TP (serum total protein)],correlation score [APACHEII,Systemic Inflammatory Response Syndrome Score(SIRS) and Multiple Organ Dysfunction Score(MODS)],and prognostic indicators:mechanical ventilation time,MODS incidence rate,and ICU length of stay.Results There were no statistically significant differences in pre-treatment nutritional indicators,critical illness scoring table,infection and inflammation indicators between the two groups.Compared with those before treatment,PCT,IL-6 and IL-8 were decreased significantly in the early group; the PCT was decreased in the late group compared with that before treatment,and IL-6 and IL-8 were not significantly different from those before treatment; the scores in the scoring table in both groups were significantly lower than those before treatment,but there was no statistically significant difference between the two groups.Compared withthose in the late group,the PCT,IL-6,and IL-8 in the early group were significantly lower than those in the late group,and the differences were statistically significant.The mechanical ventilation time and ICU length of stay in the early group were significantly shortened,and the incidence rate of MODS dropped significantly.On 7 d of the enteral nutrition,the PA value in the early group was higher than that in the late group (P<0.05).The levels of ALB and TP in the two groups were lowerr than those before treatment,and the differences were statistically significant (P<0.05); on 14d,the PA,ALB and TP in the early group were significantly higher than those in the late group,and the differences were statistically significant (P<0.05).Conclusion Early effective implementation of enteral nutrition therapy can improve the nutritional status of patients,inhibit inflammation,shorten the time of mechanical ventilation and the length of hospital stay in ICU,so as to improve the clinical efficacy and prognosis of patients undergoing AECOPD mechanical ventilation.