摘要目的: 探讨早期高蛋白营养联合康复运动在有创机械通气慢性阻塞性肺疾病急性加重(AECOPD)患者中的应用效果。方法: 选择本院AECOPD患者60例,随机分为研究组和对照组,每组30例,对照组给予有创机械通气、常规西医治疗及常规营养支持,研究组在上述基础上额外给予早期高蛋白营养联合上下肢主被动运动康复训练设备进行康复运动治疗,高蛋白质供给。方法: 第1~3天1.5g·kg-1·d-1,第4天开始1.8g·kg-1·d-1,康复运动:第1天禁止康复运动;第2~3天,早晨10min、中午15min、晚上15min;第4天开始,早晨20min、中午20min、晚上20min;疗程均从开始机械通气至脱机;对比两组患者治疗前后血清营养指标(白蛋白、转铁蛋白、前白蛋白及血红蛋白)、血清炎症指标(IL-6、TNF-α、CRP)、SOFA评分变化及肌力恢复有效率。结果: 治疗前,研究组、对照组各白蛋白、转铁蛋白、前白蛋白及血红蛋白血清营养指标对比无明显差异(P>0.05);与治疗前比较,治疗后两组患者血清营养指标均明显改善,有统计学差异(P<0.05);与对照组比较,研究组血清营养指标(血红蛋白、白蛋白、转铁白蛋白及前白蛋白)改善更明显,且有统计学差异(134.61±5.11vs119.47±5.58,46.79±1.68 vs 42.01±2.06,1.82±0.95 vs 1.42±0.09,237.82±10.81vs143.20±9.78,P<0.05);治疗前,研究组、对照组各血清炎症指标对比无明显差异(P均>0.05);治疗后,研究组各血清炎症指标较治疗前明显改善(P均<0.05),治疗后,研究组患者血清IL-6、TNF-α、CRP分别为(30.52±6.34)pg/mL、(60.13±4.76)pg/mL、(5.38±1.95)mg/L,对照组患者血清IL-6、TNF-α、CRP则分别为(36.75±10.35)pg/mL、(66.34±6.57)pg/mL、(7.31±2.34)mg/L,两组上述指标对比差异明显(P均<0.05);治疗后研究组、对照组肌力恢复有效率分别为93.33%(28/30)、83.33%(25/30),组间差异明显(P<0.05)。结论: 早期高蛋白营养联合康复运动可以改善有创机械通气AECOPD患者营养及感染状况,提高肌力,有利于患者康复及预后。
Abstract：Objective: To observe the clinical effect of early high protein nutrition combined with rehabilitation exercise on patients with invasive mechanical ventilation (AECOPD). Methods: A total of 60 patients with AECOPD admitted to our hospital was divided into research group and control group,30 cases in each group.The control group was given invasive mechanical ventilation,conventional Western medical treatment and conventional nutritional support,while the study group was given early high protein nutrition combined with active and passive exercise rehabilitation equipment for rehabilitation exercise on top of the above.On days 2~3,10 minutes in the morning,15 minutes at noon and 15 minutes in the evening; on day 4,20 minutes in the morning,20 minutes at noon and 20 minutes in the evening; from the start of mechanical ventilation to deconditioning in both groups; comparison of serum nutritional parameters (albumin,transferrin,prealbumin and haemoglobin),serum inflammatory parameters (IL-6,TNF-α,CRP),and changes in SOFA score and muscle strength recovery before and after treatment in both groups were compared. Results: Before treatment,there was no significant difference between the study group and the control group in terms of albumin,transferrin,prealbumin and haemoglobin.There was no significant difference between the serum nutritional indicators in the study group and the control group (P>0.05); compared with the pre-treatment group,the serum nutritional indicators improved significantly in both groups after treatment,with statistical differences (P<0.05); compared with the control group,the serum nutritional indicators (hemoglobin,albumin,transferrin and prealbumin) improved more significantly in the study group,with statistical differences (134.61±5.11) vs 119.47±5.58,46.79±1.68 vs42.01±2.06,1.82±0.95 vs 1.42±0.09,237.82±10.81 vs 143.20±9.78,P<0.05); before treatment,there was no significant difference in all serum inflammatory indexes between the study group and the control group (all P>0.05); after treatment,the serum inflammation indexes in the study group were significantly improved compared with those before treatment (all P<0.05),and the serum IL-6,TNF-α and CRP in the study group were (30.52 ± 6.34) pg/mL,(60.13 ± 4.76) pg/mL and (5.38 ± 1.95) mg/L,respectively,while the serum IL-6,TNF-α and CRP in the control group were (36.75 ± 10.35) pg/mL,respectively.(36.75±10.35) pg/mL,(66.34±6.57) pg/mL,(7.31±2.34) mg/L respectively in the control group,with significant differences in the above indexes between the two groups (all P<0.05); the efficiency of muscle strength recovery was 93.33% (28/30) and 83.33% (25/30) in the study group and control group respectively after treatment,with significant differences between the groups ( P<0.05). Conclusion: Early high protein nutrition combined with rehabilitation exercises can improve the nutritional and infectious status of patients with invasive mechanical ventilation in AECOPD and improve muscle strength,which is beneficial to patients' recovery and prognosis.
李树铁, 朱晓勃, 左路广, 徐博文, 王雪梅, 黄晓梦, 李福龙. 早期高蛋白营养联合康复运动在有创机械通气慢性阻塞性肺疾病急性加重中的应用[J]. 河北医学, 2023, 29(7): 1159-1163.
LI Shutie, ZHU Xiaobo, ZUO Luguang, et al. Application of Early High Protein Nutrition Combined with Rehabilitation Exercise in Invasive Mechanical Ventilation in AECOPD. HeBei Med, 2023, 29(7): 1159-1163.
2023, Vol. 29 
冀公网安备13080202000677号