管饲肠内营养支持治疗对中度慢性阻塞性肺疾病急性加重无创通气患者疗效的影响

目的探讨管饲肠内营养支持治疗对中度慢性阻塞性肺疾病急性加重（AECOPD）行无创正压通气（NPPV）治疗患者临床疗效的影响。方法选择2009年1月至2011年4月北京大学首钢医院重症医学科收治的中度AECOPD需行NPPV治疗的患者60例,随机分为管饲肠内营养组（30例）和经口摄食组（30例）。比较两组患者7 d内每日营养摄入量和累计营养摄入量,7 d后血浆前白蛋白和转铁蛋白浓度的变化,脱机成功率,无创通气时间,住ICU时间,气管插管率,以及28 d死亡率。结果与经口摄食组比较,管饲肠内营养组7 d内每日营养摄入量和累计摄入量明显增加（P〈0.05）,7 d后血浆前白蛋白（258.4±16.5）mg/L比（146.7±21.6）mg/L]和转铁蛋白（2.8±0.6）g/L比（1.7±0.3）g/L]浓度明显升高（P〈0.05）,脱机成功率明显升高（83.3%比70.0%,P〈0.05）,无创通气时间5.6（3.2～8.6）d比8.4（4.1～12.3）d]、住ICU时间9.2（7.4～11.8）d比13.6（8.3～17.2）d]明显缩短（P〈0.05）,气管插管率（16.6%比30.0%）和28 d死亡率（3.3%比10.0%）明显降低（P〈0.05）。结论管饲肠内营养较经口摄食能迅速改善中度AECOPD行NPPV治疗患者的营养状态,提高脱机成功率,缩短无创通气时间和住ICU时间,降低气管插管率和死亡率。研究结果提示对中度AECOPD行NPPV治疗的患者应首选管饲肠内营养支持治疗。

Effects of Enteral Tube Feeding on Moderate AECOPD Patients Received Noninvasive Positive Pressure Ventilation

Objective To explore the effects of enteral tube feeding on moderate AECOPD patients who underwent noninvasive positive pressure ventilation(NPPV).Methods Sixty moderate AECOPD patients with NPPV admitted from January 2009 to April 2011 were recruited for the study.They were randomly divided into an enteral tube feeding group(n=30) received enteral tube feeding therapy,and an oral feeding group(n=30) received oral feeding therapy.Everyday nutrition intake and accumulative total nutrition intake in 7 days,plasma level of prealbumin and transferrin,success rate of weaning,duration of mechanical ventilation,length of ICU stay,rate of trachea cannula,and mortality rate in 28 days were compared between the two groups.Results Compared with the oral feeding group,the everyday nutrition intake and accumulative total nutrition intake in 7 days obviously increased(P<0.05),while the plasma prealbumin (258.4±16.5)mg/L vs.(146.7±21.6)mg/L] and transferrin (2.8±0.6)g/L vs.(1.7±0.3)g/L] also increased significantly after 7 days in the enteral tube feeding group(P<0.05).The success rate of weaning(83.3% vs.70.0%),the duration of mechanical ventilation 5.6(3.2-8.6)days vs.8.4(4.1-12.3)days],the length of ICU stay 9.2(7.4-11.8)days vs.13.6(8.3-17.2)days],the rate of trachea cannula(16.6% vs.30.0%),the mortality rate in 28 days(3.3% vs.10.0%) all had significant differences between the enteral tube feeding group and the oral feeding group.Conclusions For moderate AECOPD patients with NPPV,enteral tube feeding can obviously improve the condition of nutrition and increase the success rate of weaning,shorten the mechanical ventilation time and the mean stay in ICU,decrease the rate of trachea cannula and mortality rate in 28 days.Thus enteral tube feeding should be preferred for moderate AECOPD patients with NPPV.