不同营养方式联合BiPAP呼吸机治疗对COPD患者肺功能、血氧饱和度、免疫功能及预后的影响

目的探究肠内营养(EN)与肠外营养(PN)联合双水平气道正压(BiPAP)呼吸机治疗慢性阻塞性肺疾病(COPD)的临床效果。方法选取164例通过BiPAP呼吸机治疗的COPD患者为受试对象,随机数字表法分为EN组与PN组各82例,分别采取相应方式的营养支持治疗。比较治疗前及治疗1周后两组患者肺功能指标、动脉血气指标、免疫功能指标、血清生化指标水平变化,分析两组患者撤机时间、住院时间及住院期间并发症发生情况的差异。结果治疗1周后,EN组患者深吸气量(IC)、第1秒用力呼气容积占预计值%(FEV1%)、肺一氧化碳弥散量(DLCO)、血氧饱和度(SaO2)、酸碱度(pH)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、T淋巴细胞亚群比例(CD^4+/CD^8+)、脂联素(APN)、内脏脂肪素水平均明显高于同期PN组(t分别=2.85、3.96、3.13、4.60、3.76、4.24、3.00、4.50、5.28、3.16,P均<0.05);EN组患者二氧化碳分压(PaCO2)、肿瘤坏死因子-α(TNF-α)水平均明显低于同期PN组(t分别=7.23、3.94,P均<0.05)。EN组患者撤机时间、住院时间及均明显短于PN组(t分别=3.15、2.53,P均<0.05)。两组患者各并发症发生率比较,差异均无统计学意义(χ^2分别=1.48、3.12、0.84、0.99,P均>0.05)。结论EN联合BiPAP呼吸机治疗能显著提升COPD患者肺功能、血氧饱和度、免疫功能,治疗效果相较于PN联合BiPAP更为理想,对其预后康复有利。

Effects of different nutritional methods combined with BiPAP ventilator on pulmonary function,oxygen saturation,immune function and prognosis in COPD patients

Objective To explore the clinical effects of enteral nutrition(EN)and parenteral nutrition(PN)combined with bi-level positive airway pressure(BiPAP)on chronic obstructive pulmonary disease(COPD).Methods A total of 164 COPD patients treated with BiPAP ventilator were selected and randomly divided into the EN group(n=82)and the PN group(n=82).The EN group was received enteral nutrition,the PN group was received parenteral nutrition.The pulmonary function parameters including inspiratory capacity(IC),the proportion of forced expiratory volume at 1 second in predicated value(FEV1%),diffusion capacity for carbon monoxide of the lung(DLco),arterial blood gas indexes including oxygen saturation(SaO2),partial pressure of carbon dioxide(PaCO2),potential of hydrogen(pH),immune function indexes including immunoglobulin G(IgG),immunoglobulin A(IgA),T lymphocyte subsets proportion(CD4+/CD8+),and serum biochemical indexes including tumour necrosis factor α(TNF-α),adiponectin(APN),visfatin were compared between two groups before treatment and 1 week after treatment,and the weaning time,hospital stay time and the occurrence of complications during hospitalization were compared between the two groups.Results One week after treatment,the levels of IC,FEV1%,DLco,SaO2,pH,IgG,IgA,CD^4+/CD^8+,APN and visfatin in the EN group were significantly higher than those in the PN group(t=2.85,3.96,3.13,4.60,3.76,4.24,3.00,4.50,5.28,3.16,P<0.05).The levels of PaCO2 and TNF-αin the EN group were significantly lower than those in the PN group(t=7.23,3.94,P<0.05).The withdrawal time and hospital stay time in the EN group were significantly shorter than those in the PN group(t=3.15,2.53,P<0.05).There was no significant difference in the incidence rates of different complications between the two groups(χ^2=1.48,3.12,0.84,0.99,P>0.05).Conclusion EN combined with BiPAP ventilator therapy can significantly improve the pulmonary function,oxygen saturation and immune function of COPD patients,which is beneficial to prognosis and rehabilitation.It is superior to the PN combined with BiPAP.