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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

28卷

期数:

2022年06期

页码:

631-635

栏目:

临床医学

出版日期:

2022-11-20

文章信息/Info

Title:

Efficacy of pumping and meal served enteral nutrition in patients with AECOPD combined with type Ⅱ respiratory failure and mechanical ventilation

文章编号:

1006-8147(2022)06-0631-05

作者:

冯丽伟¹; 付丽²; 魏立娜¹; 张清照¹; 刘华宇¹; 晏东波¹

1.天津医科大学第二医院重症医学科，天津300211；2.天津医科大学第二医院护理部，天津300211

Author(s):

FENG Li-wei¹; FU Li²; WEI Li-Na¹; ZHANG Qing-zhao¹; LIU Hua-yu¹; YAN Dong-bo¹

（1.Department of Intensive Care Unit，The Second Hospital，Tianjin Medical University，Tianjin 300211，China；2.Department of Nursing，The Second Hospital，Tianjin Medical University，Tianjin 300211，China ）

关键词:

肠内营养; 机械通气; 慢性阻塞性肺疾病

Keywords:

enteral nutrition; mechanical ventilation; chronic obstructive pulmonary disease

分类号:

R563.8

DOI:

-

文献标志码:

A

摘要:

目的：探讨泵入与顿服肠内营养支持对慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭的机械通气患者的疗效。方法：选取天津医科大学第二医院重症医学科2020年12月—2021年12月收治的接受肠内营养支持的AECOPD合并Ⅱ型呼吸衰竭的机械通气患者为研究对象。采用病例对照随机数字法将患者随机分为顿服组（66例）与泵入组（64例）。顿服组每日4次自鼻胃管推注肠内营养液，泵入组采用营养泵持续泵入肠内营养液；比较两组患者治疗前、后的营养状态、感染情况、肝肾功能等各项指标；两组机械通气时间、ICU住院时间、总住院时间有无差异。结果：治疗后两组营养状态，指标白蛋白、血红蛋白、总蛋白、营养筛查评分（NRS-2002）差异无统计学意义（均P>0.05）。感染指标PCT、白细胞、中性粒细胞百分比、CRP、淋巴细胞百分比、淋巴细胞计数差异无统计学意义（均P>0.05）。肝肾功能指标谷草转氨酶、谷丙转氨酶、肌酐值（Z=-1.155、-0.544、0.073，均P>0.05），差异无统计学意义。两组机械通气时间、ICU住院时间、总住院时间差异无统计学意义（Z=-0.641、-0.209、-0.721，均P>0.05）。与治疗前比顿服组营养指标均降低，泵入组重要指标均升高；与治疗前相比，两组治疗后感染指标均有改善，但肝肾功能指标未见显著变化。结论：对于慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的机械通气患者，泵入营养支持患者部分营养指标有增高趋势。两种方式对营养、感染、肝肾功能未见显著差异。临床治疗可根据危重患者实际情况选择恰当的营养支持方式。

Abstract:

Objective： To investigate the effect of enteral nutrition supported by pump and meal served on mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicated with type Ⅱ respiratory failure. Methods：Mechanical ventilation patients with AECOPD and type Ⅱrespiratory failure who received enteral nutrition support from December 2020 to December 2021 in the Department of Intensive Care Unit，The Second Hospital of Tianjin Medical University were selected. Using case-control random number method，the patients were randomly divided into the meal served group（66 cases） and the pumping group（64 cases）. Meal served group received enteral nutrition solution through nasogastric tube 4 times a day. The pumping group recieved enteral nutrient solution by a nutrient pump to continuously pump Nutritional status，infection status，liver and kidney function before and after treatment；duration of mechanical ventilation，length of ICU stay and total length of hospital stay were compared between the two groups. Results：After treatment，there was no significant difference in nutritional status between the two groups，and there was no significant difference in albumin，hemoglobin，total protein and nutritional screening score（NRS-2002） between the two groups（all P>0.05）.There were no significant differences in PCT，white blood cells，percentage of neutrophils，CRP，percentage of lymphocytes and lymphocyte count（all P>0.05）.There was no significant difference in liver and kidney function，and the indexes were aspartate aminotransferase，alanine aminotransferase and creatinine（Z=-1.155，-0.544，0.073；all P>0.05）.There was no significant difference in the duration of mechanical ventilation，length of ICU stay，and total length of hospital stay between the two groups（Z=-0.641，-0.209，-0.721；all P> 0.05）. Compared with the pre-treatment group，nutritional indicators decreased in the meal served group；the important indexes of the pumping group increased. The indicators of infection were improved compared with those before treatment，but there was no significant change in liver and kidney function in the two groups. Conclusion：For mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure, there is an increasing trend of some nutritional indexes in the pumping group. There are no significant differences in nutrition, infection, liver and kidney function between the two methods. In clinical treatment, appropriate nutritional support can be selected according to the actual situation of critically ill patients.

参考文献/References:

[1] 吴国豪. 外科重症病人营养支持治疗策略[J]. 外科理论与实践，2016，21（1）：12-15.
[2] 王颖，刘世炎. 早期营养支持降低ICU肿瘤重症患者呼吸机相关性肺炎的临床效果[J]. 现代肿瘤医学，2016，24（2）：282-284.
[3] TIAN F，HEIGHES P T，ALLINGSTRUP M J，et al. Early enteral nutrition provided within 24 hours of ICU admission：a meta-analysis of randomized controlled trials[J]. Crit Care Med，2018，46（7）：1049-1056.
[4] 丁瑜，侯惠如，李英男. 肠内营养患者胃残余量监测的研究进展[J]. 安徽医药，2018，22（2）：212.
[5] 熊胜，熊宇，杨中善，等. 肠内营养的临床研究进展[J]. 临床消化病杂志，2017，29（6）：398-401.
[6] 冯丽伟，赵岳，王思远，等. 血清白蛋白和膈肌移动度与二次插管的相互关系[J]. 天津医科大学学报，2021，27（1）：28-31.
[7] 赵辉.不同营养支持方式对慢性阻塞性肺疾病急性加重并呼吸衰竭患者营养状态、肺功能及炎性因子影响的对比研究[J]. 实用心脑肺血管病杂，2019，27（4）：77-82.
[8] 潘宇，吴伦清，陆光成. 谷氨酰胺膳食纤维和低聚果糖在老年机械通气患者肠内营养中的应用[J]. 中华老年医学杂志，2016， 35（1）：42-45.
[9] 范志文，陈思怡，汤彦. 不同方案早期营养支持治疗老年COPD并呼吸衰竭患者的效果评价[J]. 湖北科技学院学报（医学版），2017，31（6）：472-473.
[10] 黄春艳，屈敬婷，黄珍贤，等. 不同途径留置胃管对呼吸机相关性肺炎影响的研究[J]. 蛇志，2019，28（1）：17-18.
[11] 甘平，刘克远.不同肠内营养方式对ICU危重症患者发生呼吸机相关性肺炎及预后情况的影响[J]. 临床肺科杂志，2020，25（6）：850-853.
[12] BRUNI A，GAROFALO E，GRANDE L，et al. Nursing issues in enteral nutrition during prone position in critically ill patients：a systematic review of the literature[J]. Intensive Crit Care Nurs，2020， 2020（60）：102899
[13] 罗曼，冯波. 不同途径肠内营养应用于危重症患者的效果及对呼吸机相关性肺炎的影响分析[J]. 科学养生，2019，1（11）：288-289.
[14] 孙宏，李珂，杨倩，等. 不同肠内营养供给方式对老年重症肺炎的疗效研究[J]. 中华急诊医学杂志，2020，29（1）：92-98.

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备注/Memo

备注/Memo:

基金项目 天津医科大学第二医院青年科研基金（2020ydey24）
作者简介 冯丽伟（1982-），女，主管护师，硕士，研究方向：重症患者的治疗和护理；E-mail：81870129@qq.com。

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更新日期/Last Update: 2022-11-20