肠外营养支持对慢性阻塞性肺疾病营养不良患者中蛋白和肺功能的影响

目的 探讨肠外营养和肠内营养支持对合并营养不良的慢性阻塞性肺疾病（COPD）患者血清中白蛋白、前白蛋白、转铁蛋白、肺功能变化等指标的变化情况,为临床治疗COPD营养不良提供依据.方法 82例营养不良COPD患者随机分为治疗组（n=46）和对照组（n=36）.对照组使用抗生素和/或机械通气、支气管扩张剂、糖皮质激素等基础治疗配合肠内营养.治疗组加用肠外静脉营养支持,2周后比较两组患者血清中白蛋白、前白蛋白、转铁蛋白和肺功能变化.结果 入院时两组患者血清中白蛋白、前白蛋白、转铁蛋白、FEV1、FVC的比较差异无统计学意义（P＞0.05）.治疗组患者血清白蛋白、前白蛋白、转铁蛋白、FEV1、FVC均较治疗前明显改善,差异有统计学意义（P＜0.01）,对照组仅有血清白蛋白、前白蛋白、转铁蛋白三项参数较治疗前明显改善,差异有统计学意义（P＜0.01）,治疗后治疗组的血清白蛋白、前白蛋白、转铁蛋白、FEV1、FVC等指标参数均较对照组明显改善,差异有统计学意义（P ＜0.05或0.01）.对照组平均住院（17.5±3.0）天,观察组平均住院（16.0±3.0）天,两组比较差异有统计学意义（P＜0.05）,治疗组住院时间短于对照组.结论 营养支持治疗可明显改善营养不良COPD患者肺功能和低蛋白血症,与单纯肠内营养相比,肠外营养配合肠内营养取得更好的疗效.

Effect of parenteral nutrition support on serum protein and lung function of patients with malnutrition caused by chronic obstructive pulmonary disease

Objective To investigate the effect of parenteral nutrition and enteral nutrition support on the serum albumin, prealbumin, transferrin and pulmonary function of patients with malnutrition caused by chronic obstructive pulmonary disease （ COPD）, so as to provide clinical basis for treatment of COPD with malnutrition.Methods 82 cases of COPD patients with malnutrition were randomly divided into treatment group（ n = 46） and control group（ n = 36）.The control group were given conventional treatment（ the use of antibiotics and/or mechanical ventilation, bronchodilator and glucocorticoid ,etc. ）combined with enteral nutrition support, while the treatment group were given parenteral nutrition based on conventional treatment. After two weeks of treatment, changes of levels of serum albumin, prealbumin, transferrin, and of pulmonary ventilation function were compared between groups.Results On admission, there was no significant difference in serum albumin, prealbumin, transferrin, FEV 1, and FVC levels between two groups （ P 〉 0.05 ）.But after treatment, those of the treatment group improved significantly,which was significantly different from those before treatment（ P 〈0. 01 ）. Only the serum albumin, prealbumin and transferrin levels of the control group improved after treatment, and the difference was statistically significant（ P 〈0.01 ）. After treatment, the serum albumin, prealbumin, transferrin, FEV 1, and FVC levels of the treatment group improved more significantly than those of the control group, so the difference was statistically significant（ P 〈0. 05 or 0. 01 ） .The average hospital stay of the control group was（ 17. 5±3.0） days, and the treatment group（ 16. 0±3.0） days.Conclusion Nutrition support can significantly improve hypoproteinemia and lung function of COPD patients with malnutrition. Compared with the simple enteral nutrition, the parenteral nutrition combined with enteral nutrition treatment has better clinical effect.