作者：吴苏华，张宗满，梁国源，李远华，潘爱文，姚玉婷

单位：

523325广东省东莞市第八人民医院重症医学科 通信作者：吴苏华，E-mail：pojselose@163.com

单位（英文）：

Intensive Care Unit, Dongguan Eighth People's Hospital, Dongguan 523325, China Corresponding author: WU Suhua, E-mail: pojselose@163.com

关键词：

肺疾病,慢性阻塞性; 慢性阻塞性肺疾病急性加重; 呼吸功能不全; 呼吸衰竭; 机械通气; 肠内营;

关键词（英文）：

Pulmonary disease, chronic obstructive; Acute exacerbation of chronic obstructive pulmonarydisease; Respiratory insufficiency; Respiratory failure; Mechanical ventilations; Enteral nutrition; Severe feeding process;Treatment outcome

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.055

基金项目：

东莞市社会科技发展（一般）项目（202050715028828）

摘要：

背景慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者营养不良发生率较高,规范的早期肠内营养(EEN)对于改善患者预后至关重要。EEN实施过程中容易产生难以控制的肠内营养不耐受,常规的处理方法是暂停肠内营养,但会导致营养支持不连续,因此,制定合理的喂养方案,并依据规范、科学的喂养流程进行EEN对于改善患者营养状态具有至关重要的意义。目的 探讨基于重症喂养流程的EEN治疗接受机械通气的AECOPD合并呼吸衰竭患者的效果。方法 选取东莞市第八人民医院重症医学科2020年1月至2021年3月收治的接受机械通气的AECOPD合并呼吸衰竭患者74例为研究对象,按照随机数字表法分为观察组和对照组,各37例。对照组给予常规EEN治疗,观察组给予基于重症喂养流程的EEN治疗。比较两组患者喂养不耐受症状(包括恶心呕吐、腹痛、腹胀、腹泻、误吸、胃潴留)发生情况、4 d热卡达标率、7 d热卡达标率和热卡达标时间,治疗前及治疗2周后营养指标〔包括血红蛋白(Hb)、白蛋白(ALB)、总蛋白(TP)〕、炎症指标〔包括降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、乳酸(LA)〕,营养不良发生率,治疗前及治疗2周后心肺功能指标〔包括N末端脑钠肽前体(NTproBNP)、左心室射血分数(LVEF)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数〕,入住重症监护病房时间和机械通气时间。结果 观察组患者胃潴留发生率低于对照组(P<0.05)。观察组患者7 d热卡达标率高于对照组,热卡达标时间短于对照组(P<0.05)。观察组患者治疗后Hb、ALB、TP高于对照组,PCT、hsCRP、LA低于对照组(P<0.05);对照组、观察组治疗后Hb、ALB、TP分别高于本组治疗前,PCT、hs-CRP、LA分别低于本组治疗前(P<0.05)。观察组营养不良发生率低于对照组(P<0.05)。观察组患者治疗后PaO2、氧合指数高于对照组,PaCO2低于对照组(P<0.05);对照组、观察组患者治疗后NT-proBNP、PaCO2分别低于本组治疗前,LVEF、PaO2、氧合指数分别高于本组治疗前(P<0.05)。观察组患者入住重症监护病房时间和机械通气时间短于对照组(P<0.05)。结论 基于重症喂养流程的EEN可有效改善接受机械通气的AECOPD合并呼吸衰竭患者的营养状态,减轻炎症反应,改善心肺功能,缩短患者入住重症监护病房时间和机械通气时间。

英文摘要：

【Abstract】　Background The incidence of malnutrition in patients with acute exacerbation of chronic obstructivepulmonary disease (AECOPD) complicated with respiratory failure is high, and standardized early enteral nutrition (EEN)is essential to improve the prognosis of patients. It is easy to produce uncontrollable enteral nutrition intolerance during theimplementation of EEN. The conventional treatment method is to suspend enteral nutrition, but it will lead to discontinuousnutritional support. Therefore, formulating a reasonable feeding plan and carrying out EEN according to a standardized andscientific feeding process is of great significance to improve the nutritional status of patients. Objective To investigate the effectof EEN based on severe feeding process on patients with AECOPD complicated with respiratory failure receiving mechanicalventilation. Methods A total of 74 patients with AECOPD combined with respiratory failure receiving mechanical ventilation whowere admitted to the Intensive Care Unit, Dongguan Eighth People's Hospital from January 2020 to March 2021 were selected as theresearch subjects. According to the random number table method, they were divided into observation group and control group, with37 cases in each group. The control group was given routine EEN treatment, and the observation group was given EEN treatmentbased on severe feeding process. The incidence of feeding intolerance symptoms (including nausea and vomiting, abdominal pain,abdominal distension, diarrhea, aspiration, gastric retention) , 4-day heat card compliance rate, 7-day heat card compliancerate and heat card compliance time, nutritional indexes [including hemoglobin (Hb) , albumin (ALB) , total protein (TP) ]and inflammatory indicators [including procalcitonin (PCT) , high-sensitivity C-reactive protein (hs-CRP) , lactic acid (LA) ]before and after treatment, incidence of malnutrition, cardiopulmonary function indexes [including N-terminal brain peptideprecursor (NT-proBNP) , left ventricular ejection fraction (LVEF) , arterial oxygen partial pressure (PaO2) , arterial oxygen carbondioxide partial pressure (PaCO2) , oxygenation index] before and after treatment, the time of admission to the intensive care unitand the time of mechanical ventilation were compared between the two groups. Results The incidence of gastric retention inthe observation group was lower than that in the control group (P < 0.05) . The 7-day heat card compliance rate of the observationgroup was higher than that of the control group, and the heat card compliance time was shorter than that of the control group (P< 0.05) . After treatment, Hb, ALB and TP in the observation group were higher than those in the control group, while PCT, hsCRP and LA were lower than those in the control group (P < 0.05) ; after treatment, Hb, ALB and TP in the control group andobservation group were higher than those before treatment, while PCT, hs-CRP and LA were lower than those before treatment,respectively (P < 0.05) . The incidence of malnutrition in the observation group was lower than that in the control group (P < 0.05) .After treatment, PaO2 and oxygenation index in the observation group were higher than those in the control group, and PaCO2was lower than that in the control group (P < 0.05) ; after treatment, NT-proBNP and PaCO2 in the control group and observationgroup were lower than those before treatment, while LVEF, PaO2, and oxygenation index were higher than those before treatment,respectively (P < 0.05) . The time of admission to the intensive care unit and the time of mechanical ventilation in the observationgroup were shorter than those in the control group (P < 0.05) .ConclusionEEN based on severe feeding process can effectivelyimprove the nutritional status of AECOPD patients complicated with respiratory failure receiving mechanical ventilation, reduceinflammatory response, improve cardiopulmonary function, and shorten the time of admission to the intensive care unit andmechanical ventilation.

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