肠内免疫营养在慢性阻塞性肺疾病治疗中的应用

摘要

目的 探讨应用肠内免疫营养制剂对于慢性阻塞性肺疾病(COPD)患者营养状况改善效果及对免疫和急性炎性反应的影响.方法 2013年6月至2014年6月在海军总医院重症医学科住院需行机械通气的60例COPD患者,随机分为两组:免疫营养组30例和标准营养组30例.两组使用等热量肠内营养.营养素经鼻肠管使用.入院当天及每2周抽取静脉血,检测血清白蛋白(ALB)、前白蛋白(PA),C反应蛋白(CRP),白细胞介素-6(IL-6),同时在床旁测上臂肌围(MAMC)各指标,比较2组14d脱机率及机械通气时间.结果 免疫营养组患者治疗14d内的脱机率和高于匀浆膳营养组(73.3％比43.3％,P＜0.05);营养指标:第14天的前白蛋白水平[(188.4±57.5) mg/L比(174.6 ±65.7) mg/L,P＜0.05]、第14天的白蛋白水平[(32.7±4.6) g/L比(30.2 ±3.8)g/L,P＜0.05]、第28天时的上臂肌围水平高于对照组[(25.5±2.l)cm比(24.3±1.8)cm,P＜0.05],差异均有统计学意义.炎症反应参数,IL-6水平第14天时[(250.1±110.3) ng/L比(266.1±97.3)ng/L,P＞0.05],两组差异无统计学意义,第28天时[(108.5±59.6)ng/L比(165.7±76.3)ng/L,P＜0.05]免疫营养组水平低于标准营养组;CRP水平:第14天时CRP水平[(12.2±7.3)mg/L比(13.2±6.9) mg/L,P＜0.05],第28天的CRP水平[(7.5±5.0)mg/L比(9.6±5.6) mg/L,P＜0.05],免疫营养组CRP水平在第14、28天均低于标准营养组,差异有统计学意义.结论 COPD患者应用免疫肠内营养支持较匀浆膳能更好地改善患者营养状态、免疫功能、下调急性炎症反应水平.提高早期撤机成功率,是较为合适的营养支持方法.%Objective To explore the application of enteral immune nutrition preparation for chronic obstructive pulmonary disease (COPD) patients and examine the improving effects on nutritional status,immune status and acute inflammatory reaction.Methods A total of 60 cases of hospitalized COPD patients on mechanical ventilation in intensive care unit (ICU) were randomly divided into immune nutrition group (containing essential fatty acids,omega-3 fatty acids,energy 1.3 kcal/ml) (study,n =30) and standard nutrition group (self-made homogenized diet 1.2 kal/ml) (control,n =30).Two groups received an equal calorie of enteral nutrition via a nasointestinal tube.On the day of admission and every 2 weeks,venous blood samples were drawn for measuring the serum levels of albumin (ALB),prealbumin (PA),C-reactive protein (CRP) and interleukin-6 (IL-6).And the values of upper arm muscle circumference (MAMC) were recorded simultaneously bedside.The levels of mechanical ventilation and weaning rate were compared between two groups at Day 14.Results The weaning rate within 14 days in study group was higher than that in control group (73.3％ vs 43.3％,P ＜0.05).And PA at Day 14 in study group was higher than that in control group [(188.4 ±57.5) vs (174.6 ±65.7) mg/L,P ＜0.05],ALB at Day 14 also higher than control group [(32.7 ± 4.6) vs (30.2 ± 3.8) g/L,P ＜ 0.05],MAMC at Day 28 better than control group [(25.5 ± 2.1) cm vs (24.3 ± 1.8) cm,P ＜ 0.05].No significant inter-group difference in IL-6 existed at Day 14 [(250.1 ±110.3) vs (266.1 ±97.3) ng/L,P ＞0.05].The study group was lower than control group at Day 28 [(108.5 ± 59.6) vs (165.7 ± 76.3) ng/L,P ＜ 0.05].The CRP levels at Day 14 [(12.2±7.3) vs (13.2±6.9) mg/L,P＜0.05] andatDay28 [(7.5±5.0) vs (9.6±5.6) mg/L,P ＜0.05] were lower than those of control group at Days 14 and 28.Conclusion Compared with homogenized diet,immune enteral nutrition may improve the nutritional status of COPD patients,lower the levels of acute inflammatory reactions and boost the success rate of early weaning.