摘要
【目的】探讨培土生金法对慢性阻塞性肺病(COPD)机械通气患者肠内外营养支持临床疗效的影响。【方法】将COPD急性加重期合并呼吸衰竭行机械通气治疗的患者随机分为2组,试验组32例,对照组30例。两组均给予机械通气(有创或无创)、西医常规方法及肠内外营养支持治疗;试验组在上述治疗的基础上,加服中药健脾益肺冲剂(主要由红参、白术、茯苓、麦冬、桑白皮、黄芪等中药组成)治疗,并配合电针双侧足三里穴,两组疗程均为2周。观察两组治疗前后臂围和腿围,以及血清总蛋白(TP)、白蛋白(A lb)、前白蛋白(PA lb)、血红蛋白(Hb)等营养指标的变化,比较两组住院期间的病死率、撤机成功率、肠外营养治疗时间、机械通气时间(有创和无创)、营养费用和ICU住院费用等治疗结局指标,比较两组肺炎、真菌感染和上消化道出血等并发症的发生率。【结果】在营养学指标方面,试验组治疗后的TP、PA lb水平明显高于对照组(P<0.01或P<0.05),但A lb、Hb水平无明显差异(P>0.05);两组治疗后的臂围、腿围均较治疗前增加(P<0.01),且试验组治疗2周的臂围、腿围变化水平均高于对照组(P<0.05或P<0.01)。在医疗结局指标方面,两组的脱机成功率和住院期间病死率均无显著性差异(P>0.05);治疗后试验组的有创通气时间明显低于对照组(P<0.05),肠外营养时间也明显低于对照组(P<0.01),营养费用及ICU住院费用均明显低于对照组(P<0.05或P<0.01)。在相关并发症方面,试验组的真菌感染率明显低于对照组(P<0.05)。【结论】中医培土生金法可提高COPD急性加重期呼吸衰竭机械通气患者肠内外营养支持治疗的效果,改善患者的营养状态,减少营养费用和住院费用。
Objective To investigate the effect of spleen-supplementing and lung-strengthening therapy on patients with chronic obstructive pulmonary disease（COPD）treated by mechanical ventilation and enteral-parenteral nutritional support.Methods Acute exacerbation COPD patients complicated with respiratory failure treated by mechanical ventilation were randomized into group A（n=32）and group B（n=30）.The two groups received invasive or non-invasive mechanical ventilation,routine western medicine and enteral-parenteral nutritional support.Group A received oral use of Jianpi Yifei Granules（mainly composed of Radix Ginseng Destillata,Rhizoma Atractylodis Macrocephalae,Poria,Radix Ophiopogonis,Cortex Mori,Radix Astragali）and electroacupuncture（EA）on bilateral acupoints of Zusanli additionally.The treatment lasted 2 weeks.The changes of leg circumference and arm circumference,and serum levels of total protein（TP）,albumin（Alb）,prealbumin（PAlb）and hemoglobin（Hb）were observed.The outcomes of mortality rate during hospitalization,success rate of removing respiratory machine,time for parenteral nutritional support,time for invasive or non-invasive mechanical ventilation,fee for nutritional support and hospitalization fee in intensive care unit（ICU）were compared in the two groups.The incidences of complications of pneumonia,fungal infection,and upper gastrointestinal hemorrhage were also observed during mechanical ventilation.Results After treatment,serum levels of TP and PAlb were higher in group A than those in group B（P〈0.01 or P〈0.05）,but the differences of Alb and Hb were insignificant（P〉0.05）;leg circumference and arm circumference in the two groups increased（P〈0.01 compared with those before treatment）,and the increase was obvious in group A 2 weeks after treatment（P〈0.05 or P〈0.01 compared with those in group B）.For the therapeutic outcomes,the differences of mortality rate during hospitalization,and success rate of removing respiratory machine were insignificant between the two groups（P〉0.05）.Time for parenteral nutritional support,time for invasive or non-invasive mechanical ventilation,and fee for nutritional support and hospitalization fee in ICU were lower in group A than those in group B（P〈0.05 or P〈0.01）.The incidence of fungal infection during mechanical ventilation was lower in group A than that in group B（P〈0.05）.Conclusion Spleen-supplementing and lung-strengthening therapy has an enhancing effect on patients with acute exacerbation COPD treated by mechanical ventilation and enteral-parenteral nutritional support,improving the nutritional status of patients and reducing nutritional fee and hospitalization fee.
出处
《广州中医药大学学报》
CAS
2008年第1期18-22,共5页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省科技计划项目(编号:2004B33001024)
关键词
肺疾病
慢性阻塞性/中西医结合疗法
呼吸功能不全/中西医结合疗法
补脾益肺
营养支持
PULMONARY DISEASE,CHRONIC OBSTRUCTIVE /TCM-WM therapy
RESPIRATORY INSUFFICIENCY/TCM-WM therapy
SUPPLEMENTING SPLEEN AND STRENGTHENING LUNG
NUTRITIONAL SUPPORT
