低糖高脂肠内营养联合肠外营养对机械通气慢性阻塞性肺病患者营养支持的疗效分析

摘要

Objective To evaluate the therapeutic effects of low carbohydrate and high fat enteral nutrition ( EN) combined with parenteral nutrition ( PN) in treatment of patients with chronic obstructive pulmonary disease ( COPD) undergoing mechanical ventilation. Methods One hundred and thirteen patients with COPD undergoing mechanical ventilation were randomly divided into treatment group A ( n = 37), treatment group B ( n = 37) and control group ( n = 39), and were managed with low carbohydrate and high fat EN combined with conventional PN treatment, low carbohydrate and high fat EN combined with low carbohydrate and high fat PN treatment, and conventional EN combined with conventional PN treatment, respectively. Parameters of blood gas analysis, respiratory function and blood lipid were measured 1 d before nutrition treatment and 10 d after nutrition treatment, and time of weaning, days of PN and EN, hospitalization days, total cost of hospitalization and cost of nutrition treatment were recorded in each group. Results Ten days after nutrition treatment, the parameters of blood gas analysis and respiratory function in treatment group A and treatment group B were significantly improved compared with control group (P <0. 05), and those in treatment group B were significantly improved compared with treatment group A (P <0.05). Ten days after nutrition treatment, the parameters of blood lipid in treatment group A and treatment group B were significantly higher than those in control group (P < 0.05), and the parameters of blood lipid in treatment group B were significantly higher than those in treatment group A (P < 0. 05). The time of weaning, days of PN and EN, hospitalization days, total cost of hospitalization and cost of nutrition treatment in treatment group A and treatment group B were significantly lower than those in control group ( P < 0. 05), and the parameters in treatment group B were significantly lower than those in group A (P < 0. 05). Conclusion Low carbohydrate and high fat EN combined withconventional PN treatment and low carbohydrate and high fat EN combined with low carbohydrate and high fat PN treatment may yield better therapeutic effects in patients with COPD undergoing mechanical ventilation, and the latter treatment may outperform the former one.%目的 观察低糖高脂肠内营养(EN)联合肠外营养(PN)对机械通气慢性阻塞性肺病(COPD)患者营养支持治疗的效果.方法 113例机械通气COPD患者随机分为研究A组(37例)、研究B组(37例)和对照组(39例),分别给予低糖高脂EN联合常规PN支持治疗、低糖高脂EN联合低糖高脂PN支持治疗以及常规EN联合PN支持治疗.营养支持治疗前1d和治疗10 d后,测定各组患者血气分析、呼吸功能和血脂水平指标；记录患者脱机时间、PN和EN天数、住院天数、住院总费用和营养支持治疗费用.结果 营养支持治疗10d后,研究A组和研究B组血气分析和呼吸功能指标均较对照组显著改善(P＜0.05),研究B组较研究A组改善更显著(P＜0.05)；研究A组和研究B组血脂水平显著高于对照组(P＜0.05),且研究B组显著高于研究A组(P＜0.05).研究A组和研究B组脱机时间、PN和EN天数、住院天数、住院总费用、营养支持治疗费用均显著小于对照组(P＜0.05),且研究B组以上各项指标均显著小于研究A组(P＜0.05).结论 对于机械通气COPD患者,低糖高脂EN联合常规PN或联合低糖高脂PN营养支持的疗效较好,且后者疗效更为显著.