Observation of the effect of early enteral nutrition based on feeding process in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure / 中华急诊医学杂志

ABSTRACT

Objective:To investigate the effects of enteral nutrition feeding process in critically ill patients on nutritional status, inflammation indexes and cardiopulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure with mechanical ventilation.Methods:From December 2017 to January 2020, 60 patients who were diagnosed with AECOPD complicated with respiratory failure requiring mechanical ventilation were selected from the Department of Intensive Medicine of our hospital. The patients were divided into group A and group B according to the random number table method. Group A underwent conventional early enteral nutrition (EN) treatment, group B implemented early EN according to the enteral nutrition feeding process. The nutritional status, inflammation indicators, cardiopulmonary function, mechanical ventilation time and length of ICU stay before and after nutritional support between the two groups were comparedResults:After 2 weeks of nutritional support, the serum total protein (TP), albumin (ALB), prealbumin (PA) and hemoglobin (HB) in group B were increased by [(9.91±0.60)g/L, (7.6±0.58)g/L, (30.07±4.65)mg/L, and (15.43±1.18)g/L, which were significantly higher than those in group A (5.69±0.80)g/L, (4.20±0.47)g/L, (15.97±3.05)mg/L, and (6.70±0.49)g/L, respectively], and the difference between the two groups was statistically significant ( P<0.05). The high sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and plasma lactic acid (LA) in group B were decreased by 39.07±5.55, 1.24±0.22, and 1.11±0.13, which were significantly higher than those in group A (18.94±3.18, 0.58±0.17 and 0.70±0.09, respectively), and the difference between the two groups was statistically significant ( P<0.05). There was no significant difference in N-terminal-type brain urine peptide precursor (Nt-proBNP) and ejection fraction (LVEF) before and after nutritional support between groups A and B ( P>0.05). The blood oxygen partial pressure (PaO 2) and PaO 2/ inhaled oxygen fraction (FiO 2) of group B before tracheal intubation and 24 h after tracheal intubation were increased by (25.17±1.71) mmHg and (231.53±5.39)%, which were significantly higher than those of group A [(12.17±1.59) mmHg and (164.60±5.66)%, respectively]. The blood carbon dioxide partial pressure (PaCO 2) in group B was decreased by (25.26±1.66)mmHg, which was significantly higher than that in group A (20.11±1.08) mmHg, and the difference between the two groups was statistically significant ( P<0.05). The mechanical ventilation time and length of ICU stay in group B were significantly lower than those in group A (10.17±0.46) d vs (12.30±0.64) d, (15.70±0.23) d vs (17.93±0.52) d, all P<0.05). Conclusion:When compared with conventional early enteral feeding, early enteral nutrition based on the enteral nutrition feeding process in AECOPD with respiratory failure and mechanical ventilation patients can improve the nutritional status, reduce the level of inflammatory indicators and the inflammatory response, and shorten the mechanical ventilation time and length of ICU stay.