重组人生长激素联合早期胃肠内营养在有创-无创序贯通气治疗的慢性阻塞性肺疾病并呼吸衰竭病人中的应用

目的：观察重组人生长激素联合早期胃肠内营养支持在有创-无创序贯通气治疗的慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者中的作用。方法：①慢性阻塞性肺疾病急性发作合并II型呼吸衰竭患者68例入选。患者均知情同意。将患者随机分为2组：重组人生长激素联用全胃肠内营养（EEN＋rhGH）组35例,全胃肠内营养（EEN）组33例。②所有患者入ICU后均经口或经鼻气管插管和放置鼻胃管。均接受有创-无创序贯通气、抗感染、祛痰、平喘、强化血糖控制等治疗,入ICU当日开始鼻饲能全力。治疗组在一般治疗的同时给予重组人生长激素8u/天。③治疗1周时,分别测体重、上臂肌围、血清白蛋白、外周血淋巴细胞计数,总结一周内每日平均血糖水平与胰岛素用量;出ICU时总结住ICU天数、有创机械通气时间。④组内及组间计量资料差异比较分别采用配对t检验和独立样本t检验,计数资料比较进行卡方检验。结果：68例患者均进入结果分析。①营养指标：EEN组治疗后体重、上臂肌围、血清白蛋白、外周血淋巴细胞计数差别无显著性（P〉0.05）。EEN＋rhGH组治疗后体重、上臂肌围、血清白蛋白、外周血淋巴细胞计数均明显高于治疗前（P〈0.05）。治疗后两组间外周血淋巴细胞计数有显著差异。②住ICU天数和有创呼吸机带机时间：EEN＋rhGH组明显短于EEN组（P〈0.05）。③两组胰岛素使用量差异具有显著性,血糖水平组间差异无显著性。结论：短期使用重组人生长激素配合早期胃肠内营养对于接受有创-无创序贯通气的慢性阻塞性肺疾病并II型呼吸衰竭患者,可望提高其体重、营养水平和细胞免疫功能,缩短有创机械通气时间和住ICU时间;短期生长激素的使用在强化血糖控制基础上对血糖影响不大,但会增加胰岛素用量。

Application of recombinant human growth hormone combined with early enteral nutrition in noninvasive-invasive sequentially ventilated patients with chronic obstructive pulmonary disease accompanied by respiratory failure

OBJECT： To investigate the effects of recombinant human growth hormone （rbGH） combined with early enteral nutrition （EEN） in patients with acute exacerbations of chronic obstructive pulmonary disease （COPD） accompanied by type Ⅱ respiratory failure, who were noninvasive-invasive sequentially ventilated. METHODS：①68 patients with type Ⅱ respiratory failure complicated with acute exacerbations of COPD took part in the study voluntarily. They were randomly divided into rhGH ＋ EEN group （n=35） and group （n=33） . ②On base of using anti-infection, expectorants, bronchial tube relaxant, insulin to control blood glucose, all patients were placed nasal-gastric tube and trachea cannula as soon as being admitted to ICU. They were all undergoing invasive mechanical ventilation and fed with Nutrison Fibre from the same day. Besides, patients in rhGH ＋ EEN group were injected with rhGH （8u/d） for 7 days. ③At 7 days after treatment, body mass, serum albumin, the muscular perimeter of the upper arm and lymphocyte count in peripheral blood were detected. The length of ICU stay and invasive ventilated time were summarized at discharge from ICU. ④The paired t-test and one sample t-test were used for the comparison of intra-group and inter-group difference of the measurement data. The CHITEST was used for the numeration data. RESULTS： All the 68 patients with COPD accompanied by type H respiratory failure were enrolled in the study. ①Nutr/tional indexes： In the EEN group： body mass, the muscular perimeter of the upper arm, serum albumin and lymphocyte count in peripheral blood after treatment had no changes （p〉0.05） . In the EEN＋rhGH group： body mass, the muscular perimeter of the upper arm, serum albumin and lymphocyte count in peripheral blood after treatment were significantly higher than those before treatment （p〈0.05） . There was significantly difference with lymphocyte count in peripheral blood between two groups. ②Length of ICU stay and invasive ventilated time： they were all significantly shorter in the EEN＋rhGH group than in the EEN group （p〈0.05）③Mean daily blood glucose content and insulin dosage： There was significant difference in insulin dosage （p〈0.05） and no significant difference in mean daily blood glucose content （p〉0.05） between EEN ＋rbGH group and EEN group. CONCLUSION： To the patients with acute exacerbations of chronic obstructive pulmonary disease （COPD） accompanied by type Ⅱ respiratory failure, who were noninvasive-invasive sequentially ventilated, shortperiod use of rhGH accompanied with EEN can raise the nutrition status, immunity, shorten the invasive ventilated time and length oflCU stay. On base of tightly blood glucose controlled, patients＇mean daily blood glucose content keep stable, but their insulin dosage increased.