谷氨酰胺对慢性阻塞性肺疾病免疫调理和代谢支持的作用

背景：营养支持已成为慢性阻塞性肺疾病的重要治疗措施之一,然而部分营养不良的慢性阻塞性肺疾病患者存在营养支持“无反应”的现象,可能与其炎症反应过度、能量消耗增加有关.近年来免疫营养和代谢支持已成为近代营养支持范畴中的研究重点.目的：探讨营养底物谷氨酰胺对慢性阻塞性肺疾病免疫调理和代谢支持的作用.设计：随机对照实验.单位：上海第二医科大学附属新华医院.对象：选择2002-02/2002-07慢性阻塞性肺疾病急性发作患者44例,均为男性.随机分为2组：治疗组14例和对照组18例,年龄（75&;#177;9）岁.干预：对照给予单纯营养支持,治疗组给予谷氨酰胺治疗.全部患者由营养师指导按1.5&;#215;静息能量消耗的总热量饮食,其中蛋白质占热量的20%,脂肪占热量的30%,碳水化合物占热量的50%,治疗组减少蛋白质30 g,以L-谷氨酰胺30 g替代,10 g/次,3次/d,口服.10 d后检测营养指标（包括体质量、体质量指数、肱三头肌皮褶厚度、肌酐升高指数、血清白蛋白、白蛋白、转铁蛋白、脂群等）和免疫指标（包括免疫球蛋白、补体、T细胞亚群、白介素2、肿瘤坏死因子-α,C反应蛋白等）及静息能量的消耗.主要观察指标：观察治疗前后两组患者营养和免疫指标的变化.结果：32例患者均进入结果分析.[1]肱三头肌皮褶厚度：治疗组组内比较治疗前明显低于治疗后[（6.3&;#177;1.8）,（8.7&;#177;1.6）mm,（P＜0.05）],两组治疗后比较对照组明显低于治疗组（7.3&;#177;1.3,8.7&;#177;1.6）mm,（P＜0.05）].[2]前白蛋白：治疗组组内比较治疗前明显低于治疗后[（0.15&;#177;0.04,0.23&;#177;0.05）g/L,（P＜0.01）],两组治疗后比较治疗组高于对照组[（0.23&;#177;0.05,0.22&;#177;0.08）g/L,（P＜0.05）].[3]T细胞亚群：CD3治疗组组内比较治疗前明显低于治疗后[（59&;#177;10,72&;#177;10）,（P＜0.01）],两组治疗后比较对照组明显低于治疗组[（62&;#177;9,72&;#177;10）,（P＜0.01）][4]肿瘤坏死因子-α：治疗组组内比较治疗前明显高于治疗后[（72&;#177;7，56&;#177;5）ng/mL,（P＜0.05）],两组治疗后比较治疗组明显低于对照组[（56&;#177;5）vs（67&;#177;11）ng/mL,（P＜0.05）].[5]免疫球蛋白：IgG治疗组组内比较治疗后高于治疗前[（13&;#177;3,12&;#177;3）g/L,（P＜0.05）],两组治疗后比较治疗组高于对照组[（13&;#177;3,12&;#177;4）g/L,（P＜0.05）].结论：在营养支持时给予谷氨酰胺强化治疗,不仅能改善慢性阻塞性肺疾病患者的细胞免疫功能、抑制炎症反应过度表达、降低机体的能量代谢消耗,还能更进一步增加营养支持的疗效.     

谷氨酰胺对慢性阻塞性肺疾病患者营养改善及抗氧化作用

目的 评价谷氨酰胺强化肠内营养对慢性阻塞性肺疾病(COPD)患者的营养改善和抗氧化作用.方法 选择我院收治的COPD患者40例,随机分为谷氨酰胺组和常规营养组,每组各20例.常规营养组予常规肠内营养制剂,谷氨酰胺组在应用常规营养制剂的基础上加用谷氨酰胺强化肠内营养组件.两组均于治疗前与治疗后第10天采集血清测定并比较白蛋白、前白蛋白、转铁蛋白、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)含量.结果 两组治疗后白蛋白、前白蛋白、转铁蛋白、SOD、GSH-PX、MDA水平均改善,与治疗前比较,差异均有统计学意义(P＜0.05);谷氨酰胺组较常规营养组改善更明显,组间比较差异均有统计学意义(P＜0.05).结论 应用谷氨酰胺强化肠内营养制剂,可明显改善COPD患者营养状况,降低氧化应激损伤,有助于疾病的康复.     

饮食补充对慢性阻塞性肺疾病的影响

饮食补充对慢性阻塞性肺疾病的影响周满祥王柯黄顺根慢性阻塞性肺疾病（ＣＯＰＤ）患者常伴营养不良，并由此给患者带来不利影响。国内、外研究证明：营养支持可降低感染和呼吸衰竭的发生率，降低死亡率［１］。为减少此类患者发病，我们对１１例ＣＯＰＤ患者给予饮食补...     

慢性阻塞性肺疾病稳定期营养不良患者肠内营养支持的临床研究

慢性阻塞性肺疾病（COPD）是一种具有气流受限为特征的慢性呼吸系统疾病,慢性阻塞性肺疾病患者普遍存在不同程度的营养不良,其能影响到疾病的预后。因此,对慢性阻塞性肺疾病在常规治疗的基础上,应重视营养支持治疗。对此,本研究探讨COPD稳定期并营养不良患者给予肠内营养支持,取得了较好效果,现报告如下。     

慢性阻塞性肺疾病患者营养支持的研究进展

文章指出了慢性阻塞性肺疾病患者发生营养不良的机制,综述了慢性阻塞性肺疾病患者能量型方案、宏量营养素方案及微量营养素方案等营养支持方案,以及营养支持对患者的影响,以期为营养支持方案具体细节的制订提供参考。     

胃肠内外联合营养途径对慢性阻塞性肺疾病合并呼吸衰竭患者机械通气过程中的支持作用

目的：对比观察胃肠内营养和胃肠内外联合营养方式对行机械通气的慢性阻塞性肺疾病合并呼吸衰竭患者营养状况及影响预后因素的干预效应.方法：[1]选择2002-08/2004-09郑州大学第一附属医院呼吸内科住院的慢性阻塞性肺疾病合并呼吸衰竭患者36例.患者均知情同意.所有患者全部行机械通气治疗.将患者随机分为2组：胃肠内营养组14例,胃肠内外联合营养组22例.[2]于机械通气当日或次日,经鼻留置胃管.胃肠内营养组口服或胃管注入米汤、肉汤、鲜牛奶或能全素等.胃肠内外联合营养组在胃肠内营养治疗的同时给予胃肠外营养,采用200 g/L中长链脂肪乳剂250～500mL,85 g/L或114 g/L复方氨基酸注射液500 mL,注射用水溶性维生素10 mL,脂溶性维生素注射液10 mL,多种微量元素注射液10 mL,甘油磷酸钠注射液10 mL,100 g/L葡萄糖500～1 000 mL和（或）500 g/L葡萄糖100～200 mL,100g/L葡萄糖酸钙30 mL,100 g/L氯化钾40 mL,100 g/L氯化钠50 mL,正规胰岛素剂量按与葡萄糖比为1 U：6～8 g加入,每天临用前配成1 500～2 500 mL的营养液,电解质根据化验结果增减.由外周静脉或中心静脉输入,疗程10～14 d.[3]治疗2周时,分别测体质量、血清白蛋白、外周血淋巴细胞计数、上臂肌围;出院时总结住院天数、带机时间、撒机成功率及不良反应的发生情况.[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;率的比较采用四格表精确概率法.结果：慢性阻塞性肺疾病合并呼吸衰竭患者36例均进入结果分析.[1]营养指标：胃肠内营养组治疗后体质量、血清白蛋白、上臂肌围明显低于和小于治疗前（t=2.214～5.77,P＜0.05～0.01）,淋巴细胞计数差别几乎无变化（P＞0.05）.胃肠内外联合营养组治疗后体质量、血清白蛋白、淋巴细胞计数均明显高于治疗前（t=-2.280～-3.735,P＜0.05～0.01）,上臂肌围有增加趋势,但仍与治疗前相近（P＞0.05）.[2]住院天数：胃肠内外联合营养组明显少于胃肠内营养组[（19.50&;#177;4.14）,（29.79&;#177;10.61）d,t=3.47,P＜0.05].[3]带机时间：胃肠内外联合营养组明显短于胃肠内营养组[（12.73&;#177;4.03）,（24.07&;#177;13.37）d,t=3.09,P＜0.01].[4]撒机成功率及不良反应发生情况：胃肠内营养组3例患者未能撤机,撤机成功率79%,胃肠内外联合营养组全部成功撤机,胃肠内营养组院内腹胀、腹泻、误吸的发生例数均多于胃肠内外联合营养组,但两组仍相近（5,4,2例;2,1,0例,P＞0.05）.结论：胃肠内营养组经过治疗后,不仅体质量下降,上臂肌围也明显下降,这些均是其不良预后的重要因素,不利于慢性阻塞性肺疾病患者的康复.胃肠内营养组住院天数、带机时间都明显长于胃肠内外联合营养组.胃肠内外联合营养组腹胀、腹泻、呕吐、误吸不良反应发生较少.     

肺功能训练和营养支持对慢性阻塞性肺疾病患者的效果

目的 探讨肺功能训练和营养支持在慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者稳定期护理中的效果.方法 选择2011年12月-2012年9月就诊于四川省自贡市第一人民医院的COPD患者42例,随机分为实验组22例和对照组20例.对照组予以常规护理和常规饮食,实验组在对照组基础上予以肺功能训练,并根据患者情况予以营养支持治疗.两组患者均予以8周治疗,采用改良的英国医学研究委员会呼吸困难指数（MMRC）评估患者呼吸困难程度,1秒用力呼气量（FEV1）/用力肺活量（FVC）评估患者气流受限程度,体质指数（BMI）评估患者营养状况,6 min步行试验（6 MWT）评估患者运动功能.结果 两组患者治疗前后MMRC评分、FEV1/FVC、BMI和6MWT比较差异均具有统计学意义（P＜0.05）.结论 肺功能训练合并营养支持治疗能够改善COPD患者营养状况,缓解患者呼吸困难及气流受阻程度,提高患者运动能力,有助于COPD患者的康复.     

不同营养支持手段对慢性阻塞性肺疾病患者营养状况的影响

慢性阻塞性肺疾病 (ＣＯＰＤ )患者普遍存在营养不良 ,营养状况直接影响着ＣＯＰＤ的病程演进和预后[1,2 ] 。为患者提供营养支持成为治疗措施的合理组成部分。本组研究的目的是比较不同营养手段对ＣＯＰＤ患者营养状况的影响 ,为ＣＯＰＤ患者进行科学的营养支持提供理论依据。     

慢性阻塞性肺疾病机械通气患者肠内营养支持的护理

目的:探讨慢性阻塞性肺疾病(COPD)机械通气患者肠内营养支持的作用及护理。方法:46例患者分为两组,实验组予肠内营养4周,对照组给予一定的糖、脂肪、氨基酸进行常规输注、每周2次测定所有病人的血清白蛋白(ALB),前白蛋白(PAB),转铁蛋白(TFN),IgA,IgG,IgM及一次脱机成功率。结果:治疗2周末,实验组PAB,TFN及IgA,IgG,IgM均显著高于对照组(P<0.05)。治疗4周末,实验组所有指标均显著高于对照组(P<0.05)。结论:肠内营养是COPD机械通气患者的一项重要治疗措施,良好细致的护理是保证其成功实施的关键。     

早期营养支持对慢性阻塞性肺疾病病人肺功能恢复的影响

[目的]探讨慢性阻塞性肺疾病(COPD)病人早期营养支持对肺功能恢复的影响.[方法]将70例COPD病人随机分为对照组和营养组,两组均给予支气管扩张剂、祛痰药、抗感染治疗等常规综合治疗.营养组在此基础上,由责任护士负责对COPD病人进行早期营养支持治疗,包括早期肠内营养及肠外营养辅助互补.2周后观察肺功能指标变化.[结果]营养组营养指导治疗后第1秒用力呼气容积(FEV1)、用力肺活量(FVC)明显高于治疗前及对照组(P＜0.01).[结论]早期营养支持有助于改善COPD病人肺功能,从而提高COPD病人抢救成功率,对COPD病人治疗具有积极的意义.     

Need of support in people with chronic obstructive pulmonary disease

Aim and objective

The aim of this study was to describe peoples’ experiences and expectations of support when living with chronic obstructive pulmonary disease.

Method

We conducted and analysed face‐to‐face or telephone interviews with 17 individuals (aged 44–77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open‐ended questions aimed at encouraging further narration, and we analysed the participants’ narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines.

Results

The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self‐reliance versus self‐blame, and the Internet – feeling safe but uncertain.

Conclusions

People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person‐centred eHealth approach may be suitable for this group as it offers both collaboration and support.

Relevance to clinical practice

There is a demand for access to genuine professional knowledge as additional support to patients’ own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.     

Depression in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in adults in the United States and worldwide. Depression is a common comorbidity in this population, but often goes undiagnosed in persons with COPD. Because the presence of depression has the potential to negatively impact COPD-related outcomes, it is essential for health care practitioners involved in the care of patients with COPD to diagnose and treat COPD and the associated comorbidities, including depression. Although there is a lack of comprehensive guidelines for treating depression in those with COPD, an algorithm has been proposed to screen and manage depression in these patients. Several questionnaires are available that can be used to assess and assist in diagnosing depression in these patients. Following diagnosis, antidepressant therapy should be considered along with nonpharmacological strategies, such as pulmonary rehabilitation and cognitive behavioral therapy.     

Fatigue in patients with chronic obstructive pulmonary disease

BACKGROUND: Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients' perceptions of fatigue and the impact of perceived fatigue on their everyday lives. OBJECTIVE: The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls. METHOD: The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age- and sex-matched controls. In total 36 patients and 37 controls completed the questionnaire. RESULTS: Almost half of the patients (47.2%), reported fatigue every day during the preceding month compared with 13.5% of the control group (P < 0.001). The duration of fatigue was more than 6 hours in 52.7% of the patients and 44.4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18.9% (P < 0.001) and 10.8% (P < 0.01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0.001). CONCLUSION: These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients' functional condition and needs to be professionally assessed and managed.     

Arrhythmias in patients with chronic obstructive pulmonary disease

Cardiac arrhythmias are commonly associated with chronic obstructive lung disease and these arrhythmias can impair arterial blood oxygenation. The etiology of the arrhythmias is multifactorial. The treatment of the arrhythmias is largely the treatment of the deranged physiology and the underlying pulmonary disease. The association of arrhythmias with chronic obstructive lung disease portends a poor prognosis.     

慢性阻塞性肺疾病病人规范化治疗

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是危害公众健康的常见慢性疾病之一,目前是世界上第4位主要死亡原因.     

Transitional care for patients with chronic obstructive pulmonary disease

ObjectivesTo observe the effects of transitional care on the quality of life of chronic obstructive pulmonary disease (COPD) patients.MethodsA total of 114 COPD patients were recruited from the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China and divided equally into an intervention group and control group. Following discharge, patients from the intervention group recieved three-months intervention in addition to regular nursing care, while control group patients received regular nursing care only. Patients' quality of life was measured using the St. George's respiratory questionnaire (SGRQ), the 12-item General Health Questionnaire (GHQ-12) and body mass index (BMI).ResultsThe symptoms section score, the activity section score, the impacts section score, the total score and the rate of mental disorders were significantly changed after the intervention while there was no statistical difference in BMI between groups.ConclusionsTransitional care can improve health-related quality of life in COPD patients who have recently suffered an exacerbation.     

慢性阻塞性肺疾病病人规范化治疗

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是危害公众健康的常见慢性疾病之一，目前是世界上第4位主要死亡原因。COPD现已引起世界各国的重视，在我国COPD占据死因第3位，而在农村则占死因首位。COPD是以呼气气流受限为特征的病变，临床上表现为咳嗽、咳痰及呼吸困难。COPD发病多年后出现的呼吸困难症状是病人求医的主要原因，也是最终导致病人日常活动受限的主要因素之一。由于其迁延不愈，反复发作，病程长，病情复杂，易反复感染且呈进行性加重，严重影响病人的劳动能力和生活质量，给病人身心造成极大痛苦，给社会及个人经济带来严重损失。为普及㈣的防治知识及推广慢性阻塞性肺疾病全球创议（C-OLD），达到控制发作、预防复发、气道重建以及降低致残致死率及节约医疗资源开支的目的，我院于2003年在全市率先成立了COPD俱乐部（以下简称俱乐部）及郊区农村COPD防治网络。