ABSTRACT
Objective To observe the clinical effect of high fat and low carbohydrate enteral nutrition (EN) for treatment of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV). Methods Fifty-six COPD patients with MV admitted to the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Zhuji from May 2014 to July 2017 were enrolled, and they were randomly divided into an experimental group administered with high fat and low carbohydrate EN (28 cases) and a control group administered with high carbohydrate and low fat EN (28 cases ), the therapeutic course being two weeks in both groups. After two weeks of treatment, the pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), every minute ventilation volume (VE), oxygen consumption volume (VO2), carbon dioxide production volume (VCO2), total peripheral blood lymphocyte count (TLC), immunoglobulins (IgA, IgG, IgM), MV time, weaning success rate and survival rate were detected and compared between the two groups. Results Two weeks after nutritional support treatment, PaCO2, PaO2, VCO2, VO2, VE, TLC were all significantly improved in experimental group compared with those in control group [PaCO2(mmHg, 1 mmHg = 0.133 kPa): 48.37±10.22 vs. 55.34±9.87, PaO2(mmHg): 73.45±14.68 vs. 67.43±7.38, VCO2(mL): 264±22 vs. 287±30, VO2(mL): 316±35 vs. 344±22, VE (L/min): 10.0±1.6 vs. 11.6±1.9, TLC (×109/L): 1.62±0.73 vs. 1.21±0.21, all P < 0.05], MV time was significantly shorter in experiment group than that in control group (days: 6.89±1.15 vs. 8.78±1.29), weaning success rate and survival rate were significantly higher in experiment group than those in control group [weaning success rate: 67.9% (19/28) vs. 42.9% (12/28), survival rate:89.3% (25/28) vs. 78.6% (22/28), both P < 0.05]. Conclusion High fat and low carbohydrate EN can improve the ventilation and immune indexes in COPD patients with MV, shorten the MV time and increase the weaning success rate and survival rate.
ABSTRACT
Objective To observe the incidence of malnutrition, the therapeutic effect of nutritional support and the prognosis of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV) in patients with different traditional Chinese medicine (TCM) syndrome types and discuss the relationships between these indicators and the differentiation of cold-heat/deficiency-excess syndrome. Methods One hundred and three patients with COPD and MV admitted to Zhuji Hospital of TCM from September 2015 and July 2017 were enrolled, according to the different TCM syndromes, they were divided into an excess-heat syndrome group 42 cases and an asthenia-cold syndrome group 61 cases, and the differences in nutrition indexes and prognosis between the two groups were compared. Results The acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, nutritional risk screening 2002 (NRS2002) score and the incidence of malnutrition in excess-heat syndrome group were significantly lower than those in the asthenia-cold syndrome group, while the body mass index (BMI) in excess-heat syndrome group was obviously higher than that in the asthenia cold syndrome group [APACHE Ⅱ score: 20.1±5.4 vs. 22.0±3.4,NRS2002 score: 5.2±0.6 vs. 6.2±0.8, incidence of malnutrition: 61.9% (26/42) vs. 80.3% (49/61), BMI (kg/m2): 22.6±3.8 vs. 19.9±4.8, all P < 0.05]. The levels of albumin (Alb), prealbumin (PA) and transferrin (TF) of the excess-heat syndrome group were higher than those in the asthenia-cold syndrome group, and the differences between the two groups were statistically significant on the 7th day under MV [Alb (g/L): 36.14±2.97 vs. 34.40±3.37, PA (mg/L): 237.67±28.01 vs. 185.34±30.86, TF (g/L): 2.13±0.38 vs. 1.95±0.12, all P < 0.05]. In the excess-heat syndrome group, the percentage of weaning from MV was higher than that of the asthenia-cold syndrome group [85.7% (36/42) vs. 65.6% (40/61)], the 28-day mortality [14.3% (6/42) vs. 31.1% (19/61)] and ICU stay time (days: 9.21±2.96 vs. 11.13±3.96) were lower than those of the asthenia cold syndrome group (all P < 0.05). Conclusion The analysis of TCM differentiation of cold-heat/deficiency-excess syndrome has a certain reference value to realize the changing rules in nutritional status and prognosis of patients with COPD under mechanical ventilation.
ABSTRACT
Objective To observe the clinical effect of recombinant human growth hormone on mechanical ventilation in chronic obstructive pulmonary disease ( COPD) patients complicated with respiratory failure .Methods 31 COPD patients complicated with respiratory failure were randomly divided into rhGH treatment group and control group .All the patients were given antibiotics ,expectorants ,bronchodilators ,glucocorticoid and nutritional support ther-apy.The treatment group was given subcutaneous injection of rhGH ,9u/d,7~14d.The plasma-albumin,prealbumin, ureanitrogen,creatinine,GOT,dailyaveragebloodglucose ,lymphocytecount,C-reactiveprotein,tionofmechanical ventilation,ICU stays were observed pretherapy and post-treatment.Results The plasma total protein,plasma-albu-min,prealbumin,lymphocyte count of the treatment group were significantly higher than those of the control group (P<0.05),(60.3 ±12.8)g/L vs (55.6 ±10.7 )g/L,(38.5 ±5.4)g/L vs (34.6 ±3.6)g/L,(2.3 ±0.2)g/L vs (2.0 ±0.1)g/L,(1.15 ±0.17) ×109/L vs (1.02 ±0.18μ) ×109/L respectively,while C-reactive protein in the treatment group was significantly lower than control group [(8.4 ±3.7)mg/L vs (12.5 ±2.4 )mg/L](P<0.05), blood glucose in the treatment group was slightly higher than control group (6.9 ±1.1) mmol/L vs (6.5 ±0.8 ) mmol/L(P<0.05),the duration of mechanical ventilation and ICU stay time in the treatment group were shorter than those in control group [(13.2 ±3.2)days vs (16.8 ±3.7)days,(17.2 ±2.5)days vs (21.8 ±2.7)days].Conclu-sion Recombinant human growth hormone could help in shortening duration of mechanical ventilation and ICU stays for COPD patients complicated with respiratory failure .