A clinical study on the effect of early activities on risk factors of acute gastrointestinal injury in patients with chronic obstructive pulmonary disease induced by mechanical ventilation / 中国医师杂志

ABSTRACT

Objective To investigate the effect of early activities on risk factors of acute gastrointestinal injury (AGI) in patients with chronic obstructive pulmonary disease (COPD) induced by mechanical ventilation.Methods A total of 118 mechanically ventilated non-diabetic patients with chronic obstructive pulmonary disease who were admitted to our hospital from August 2017 to April 2018 were enrolled in the study.The patients were divided into AGI group (71 cases) and non-AGI group (47 cases) according to the presence or absence of AGI.The examined data were collected in the patients prospectively such as preprocalcitonin (PCT),D-lactic acid,serum albumin (ALB),fasting plasma glucose (FPG),fasting insulin (FINS),and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores were calculated.The homeostasis model insulin resistance index was used (HOMA-IR) to assess the subjects' insulin resistance.Logistics regression analysis screened for risk factors that affected patients' AGI.The AGI patients were divided into treatment group (36 cases) and control group (35 cases) according to the random number table method.On the basis of the same conventional treatment,the treatment group were received early mobilization.The differences of PCT,D-lactate,FPG,HOMA-IR,APACHE Ⅱ scores,and AGI grades before and after treatment for 3 days were observed for both groups of patients.Results The PCT,D-lactate,FPG,HOMA-IR,and APACHE Ⅱ scores were higher in the AGI group than in the non-AGI group [(2.72 ±0.54)ng/ml vs (1.81 ±0.62)ng/ml;(17.43 ±2.63)mg/ml vs (13.61 ± 1.6)mg/ml;(10.1 ±l.0)mmol/L vs (8.4 ±0.9) mmol/L;(2.4 ±0.5) vs (1.7 ±0.4);(23.8 ±2.9) point vs (21.7 ±4.3)point],and the ALB were lower than non-AGl group [(29.1 ±2.2)g/L vs (30.6 ±3.2)g/L],with statistically significant difference (P ＜ 0.05).Multivariate logistic regression analysis showed that PCT,D-lactic acid,FPG,HOMA-IR,and APACHE Ⅱ scores were risk factors for AGI in mechanically ventilated non-diabetic patients with COPD (regression coefficients were 4.337,1.226,5.106,4.469,0.584 respectively,P ＜0.05).There were no significant difference in PCT,D-lactate,FPG,HOMA-IR,APACHE Ⅱ scores between the treatment group and the control group before treatment (P ＞ 0.05).The PCT,D-lactic acid,FPG,HOMA-IR,and APACHE Ⅱ scores in the treatment group were significantly lower than those in the control group after early treatment [(2.00 ± 0.49) ng/ml vs (2.34 ± 0.34) ng/ml;(15.38 ± 1.71)mg/ml vs (17.38 ±2.88)mg/ml;(8.9 ±0.9)mmol/L vs (9.6 ±0.7)mmol/L;(1.9 ± 0.4) vs (2.2 ± 0.4);(21.0 ± 1.8) point vs (22.2 ± 2.7) point],and AGI severity was reduced (There were 8,18,6,3 and 1 cases of 0,Ⅰ,Ⅱ,Ⅲ,and Ⅳ in the treatment group,and4,12,9,7 and 3 in the control group respectively),with statistically significant differences (P ＜ O.05).Conclusions PCT,Dlactic acid,FPG,HOMA-IR,and APACHE Ⅱ scores were risk factors for AGI in mechanically ventilated non-diabetic patients with COPD.Early mobilization could reduce the level of these risk factors and the severity of AGI.