| 程明琨,吴冠楠,王晓静,等.肠内外联合营养支持改善慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭39 例[J].安徽医药,2022,26(9):1804-1809. |
| 肠内外联合营养支持改善慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭39 例 |
| Efficacy of combined enteral and parenteral nutritional support in improving chronic obstructive pulmonary disease with type Ⅱ respiratory failure in 39 cases |
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| DOI：10.3969/j.issn.1009-6469.2022.09.025 |
| 中文关键词: 肺疾病，慢性阻塞性 呼吸功能不全 胃肠外营养 肠道营养 营养状况 Th1/Th2细胞 |
| 英文关键词: Pulmonary disease, chronic obstructive Respiratory insufficiency Parenteral nutrition Enteral nutrition Nutritional status Th1/Th2 cells |
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| 摘要点击次数: 1516 |
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| 中文摘要: |
| 目的探究肠内外联合营养支持改善慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭病人疗效作用。方法选取2017年10月至2019年10月新乡医学院第一附属医院117例COPD伴Ⅱ型呼吸衰竭病人，采用随机数字表法分为三组，各39例。常规治疗基础上，对照A组采取肠内营养支持，对照B组采取肠外营养支持，试验组采取肠内外联合营养支持，疗程均为10~14 d。统计三组呼吸困难缓解时间、住院时间，对比治疗前后肺功能指标［第1 秒用力呼气容积(FEV1)、FEV1 占预计值百分比(FEV1%)、用力肺活量(FVC)］、呼吸力学参数［气道阻力、静态顺应性(Cst)、呼吸频率］、营养状况［血红蛋白、转铁蛋白、总淋巴细胞计数(TLC)、白蛋白、前白蛋白］、Th1/Th2细胞水平及血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、γ干扰素水平。结果试验组住院时间、呼吸困难缓解时间短于对照A组、对照B组(P<0.05)；治疗后试验组FEV1(1.95±0.35)L、FEV1%(75.13±5.56)%、FVC(2.81±0.48)L水平高于对照A组［(1.80±0.42)L、(68.03±5.01)%、(2.66±0.41)L］、对照B组［(1.71±0.37)L、(62.36±5.40)%、(2.52±0.44)L］(P<0.05)；治疗后试验组Cst(33.85±3.05)mL/cmH2O高于对照A组(28.75±2.69)mL/cmH2O、对照B组(25.54±3.13)mL/cmH2O，呼吸频率(17.43±2.23)次/分、气道阻力(10.45±2.12)cmH2O·L11·s11低于对照A组［(20.84±3.56)次/分、(14.33±2.76)cmH2O·L11·s11］、对照B 组［(24.05±2.75)次/分、(17.04±3.17)cmH2O·L11·s11］(P<0.05)；治疗后试验组TLC(1.95±0.74)×109/L、转铁蛋白(3.02±0.82)g/L、血红蛋白(130.15±7.55)g/L、白蛋白(40.18±12.05)g/L、前白蛋白(265.42±30.83)mg/L水平高于对照A组［(1.56±0.68)×109/L、(2.61±0.75)g/L、(115.44±6.31)g/L、(34.49±10.35)g/L、(239.68±25.53)mg/L］、对照B组［(1.32±0.70)×109/L、(2.35±0.66)g/L、(106.46±8.23)g/L、(30.12±9.04)g/L、(216.12±27.59)mg/L］(P<0.05)；治疗后试验组Th1(9.88±2.26)%、Th1/Th2(1.53±0.78)水平高于对照A组［(8.72±2.03)%、(1.15±0.58)］、对照B组［(8.26±2.31)%、(0.95±0.61)］，Th2(6.44±2.72)%水平低于对照A组(7.56±2.08)%、对照B组(8.72±1.65)%(P<0.05)；治疗后试验组血清γ干扰素(9.65±1.32)ng/L、TNF- α(98.11±25.24)ng/L 水平低于对照A 组［(12.33±2.01)ng/L、(114.45±27.49)ng/L］、对照B 组［(15.06±1.68)ng/L、(146.38±20.25)ng/L］，IL-10水平(15.61±1.37)ng/L高于对照A组(11.23±1.24)ng/L、对照B组(8.84±1.41)ng/L(P<0.05)。结论肠内外联合营养支持应用于COPD伴Ⅱ型呼吸衰竭病人，可改善肺功能、呼吸功能及营养状况，调节Th1/Th2细胞及其分泌相关因子水平，缩短呼吸困难缓解时间、住院时间。 |
| 英文摘要: |
| Objective To explore the efficacy of combined enteral and parenteral nutritional support in improving chronic obstructive pulmonary disease (COPD) with type Ⅱ respiratory failure.Methods A total of 117 COPD patients with type Ⅱ respiratory failure from October 2017 to October 2019 in The First Affiliated Hospital of Xinxiang Medical College were selected and divided into three groups by the random number table method, with 39 cases in each group. On the basis of conventional treatment, control group A received enteral nutrition support, control group B received parenteral nutrition support, and the experimental group received combined enteral and parenteral nutritional support for 10-14 days. The relief time of dyspnea and hospital stay in the three groups were counted,and the pulmonary function indexes [forced expiratory volume in 1 second (FEV1), percentage of FEV1 to predicted value (FEV1%),forced vital capacity (FVC)], respiratory mechanics parameters [airway resistance, static compliance (Cst), respiratory rate], nutritional status [hemoglobin, transferrin, total lymphocyte count (TLC), albumin, prealbumin], Th1/Th2 cell levels and serum interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and interferon-γ levels before and after treatment were compared.Results The hospitalization time and dyspnea remission time in the experimental group were shorter than those in the control A and B groups (P < 0.05). After treatment,the levels of FEV1 (1.95±0.35) L, FEV1% (75.13±5.56)%, and FVC (2.81±0.48) L in the experimental group were higher than those in the control group A [(1.80±0.42) L, (68.03±5.01)%, (2.66±0.41) L], and control group B [(1.71±0.37) L, (62.36±5.40)%, (2.52±0.44) L] (P < 0.05); the level of Cst in the experimental group was (33.85±3.05) mL/cmH2O higher than the control group A [(28.75±2.69) mL/cmH2O] and control group B [(25.54±3.13) mL/cmH2O], the respiratory rate (17.43±2.23) times/min and airway resistance(10.45±2.12) cmH2O·L11·s11 were lower than those of the control group A [(20.84±3.56) times/min, (14.33±2.76)cmH2O·L11·s11] and control group B [(24.05±2.75) times/min, (17.04±3.17) cmH2O·L11·s11] (P < 0.05); the levels of TLC (1.95±0.74)×109/L, transferrin(3.02±0.82) g/L, hemoglobin (130.15±7.55) g/L, albumin (40.18±12.05) g/L, and prealbumin (265.42±30.83) mg/L in the experimental group were higher than those in the control group A [(1.56±0.68) ×109/L, (2.61±0.75) g/L, (115.44±6.31) g/L, (34.49±10.35) g/L,(239.68±25.53) mg/L] and control group B [(1.32±0.70)×109/L, (2.35±0.66) g/L, (106.46±8.23) g/L, (30.12±9.04) g/L, (216.12±27.59) mg/L] (P < 0.05); the levels of Th1 (9.88±2.26)%, Th1/Th2 (1.53±0.78) in the experimental group were higher than those in the control group A [(8.72±2.03)%, (1.15±0.58)] and control group B [(8.26±2.31)%, (0.95±0.61)], Th2 (6.44±2.72)% levels were lower than those in control group A (7.56±2.08)% and control group B (8.72±1.65)% (P < 0.05); the serum levels of interferon-γ (9.65±1.32) ng/L and TNF-α (98.11±25.24) ng/L in the experimental group were lower than those in the control group A [(12.33±2.01) ng/L, (114.45±27.49)ng/L] and control group B [(15.06±1.68) ng/L, (146.38±20.25) ng/L], and the IL-10 level (15.61±1.37) ng/L was higher than control group A (11.23±1.24) ng/L and control group B (8.84±1.41) ng/L (P < 0.05).Conclusion Combined enteral and parenteral nutrition support in patients with COPD and type Ⅱ respiratory failure can improve pulmonary function, respiratory function and nutritional status,regulate the levels of Th1/Th2 cells and their secretion-related factors, and shorten the duration of dyspnea remission and hospital stay. |
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