【作者】 徐震；

【导师】 李立；

【作者基本信息】 吉林大学 ， 内科学， 2009， 硕士

【摘要】 目的:探讨急性发作期慢性阻塞性肺病患者的营养状况对机体免疫和通气功能的影响,为加强慢性阻塞性肺病合并呼吸衰竭病人的营养支持治疗提供依据,以及时进行有效的营养干预,从而提高其生活质量,减少发病次数。方法:收集2008年3月至2009年3月因COPD急性加重(AECOPD)入住中日联谊医院呼吸内科53例患者,并除外肝、肾、消化道疾病及结核、恶性肿瘤、甲状腺功能亢进等消耗性疾病。检测如下六项指标(1)实际体重与标准体重百分比(%IBW);(2)血清白蛋白(ALB);(3)外周血淋巴细胞计数(TLC)=淋巴细胞百分数X白细胞计数; (4)肺功能:用意大利进口肺量计,检测第1秒用力呼气量(FEV1),并计算第1秒用力呼气量与用力肺活量百分比(FEV1%); (5)用血气分析仪测定患者的动脉血PH值、氧分压(P02)、二氧化碳分压(PC02);(6)住院天数。依据轻度: FEV1 / FVC < 70 %、FEV1≥80 %预计值,有或无慢性咳嗽、咳痰症状;极重度: FEV1 / FVC < 70 %、FEV1 < 30 %预计值,或FEV1 < 50 %预计值,并伴有慢性呼吸衰竭或右心衰竭临床表现,将慢性阻塞性肺病分为轻度及极重度两组,对比分析其营养、免疫、肺功能、血气及住院情况。结果:实际体重占理想体重的百分比(%IBW)、一秒用力呼气量(FEV1)及FEV1和用力肺活量(FVC)百分比、动脉血二氧化碳分压(PCO2)、住院天数两组之间有显著性差异(P<0.05)。结论:慢性阻塞性肺病患者的营养状况和病情严重程度密切相关,加强慢性阻塞性肺病患者的营养状况可改善其预后。更多还原

【Abstract】 Chronic obstructive pulmonary disease (COPD) is a kind of disease that could be prevented and treated, and it holds a characteristics that the airflow can berestricted .But the airflow limitation was not fully reversible ,it develops progressively, in relation to the lung’s abnormal inflammations reaction to the harmful gases and harmful particles . Because of its high morbidity and mortality, and there is an increasing trend year by year, COPD has serious negative impact on the labor force and quality of life. COPD is currently the world’s fourth cause of death, the World Bank / WHO announced COPD will be the fifth financial burden of the diseases in the world’s by 2020 . In our country COPD is also an important chronic respiratory diseases which seriously endangers the health of the people, and is the most common cause leading to chronic respiratory failure and chronic pulmonary heart disease . The main damage of COPD is in lung ,but it may also cause the systemic effects . To chronic obstructive pulmonary disease patients, their exercise endurance was reduced, activity was restricted, quality of life was decreased. Recent study found that in COPD patients skeletal muscle dysfunction and weight loss are widespread, and is associated with lower endurance exercise. Non-fat weight loss of patients with COPD can affect the respiratory muscles and peripheral muscle function, exercise capacity, health status and prognosis. Reducing body mass index in patients with acute exacerbation of COPD is a bad indicator, increase their hospitalization rate, mortality and rate of mechanical ventilation, and the survival time Closely related to their body mass index .Acute stage in patients with chronic obstructive pulmonary disease has often accompanied by malnutrition, incidence of it is up to 50.6% ~ 69.9% and the weight loss is its outstanding performance , 60 percent of them weight less than ideal body weight, by the chronic long-term consumption of basic pulmonary disease or absorption barriers, reduce consumption or acute severe lung infection caused by the high metabolic state, manifested as respiratory muscle atrophy, decreased contractile force, endurance and reduce the pulmonary defense functional decline, etc.. Surfactant reduced, and thus easy to alveolar collapse, and severe malnutrition make the respiratory center,s reactivity to hypoxia and hyperpyemia reduce, all the above are easily induced by respiratory failure. In addition, the patient with mechanical ventilation will become difficult to remove the machince. Therefore, nutrition therapy for chronic obstructive pulmonary disease patients with respiratory failure is an important instrument.Objective: To investigate the acute exacerbation of chronic obstructive pulmonary disease in patients with nutritional status on immune function and ventilation, as well as provide the basis for the treatment of nutritional support for patients with chronic obstructive pulmonary disease who has respiratory failure, conduct effective nutrition intervention, and thus improve their quality of life, reduce the incidence of the number.Methods: From March 2008 to March 2009 ,there were 53 patients who were by AECOPD due to China-Japen Union Hospital of Jilin University,and except patient with liver, kidney, digestive tract diseases and tuberculosis, cancer, hyperthyroidism etc. The definition of acute exacerbation of the COPD is the continued deterioration beyond the day-to-day situation and the COPD patients who need to change the basis of the conventional drug , in the disease process, patients usually with the aggravation of cough、sputum、shortness of breath and (or) pant in short-term, the increase of sputum volume ,in viscosity purulent or purulent, inflammation may be associated with fever. COPD in line with the diagnosis and treatment guidelines of Chronic Obstructive Pulmonary Disease Study Group which is attached to the Pulmonary Disease Study Group of Chinese Medical Association to set down in 2007.Detected the following six index:(1) the percentage of actual body weight to standard body weight (% IBW); (2) serum albumin (ALB); (3) peripheral blood lymphocyte count (TLC) = lymphocyte percentage X white blood cell count;: (4) pulmonary function and blood gas analysis: Using Italy spirometer to detect the first one second forced expiratory volume (FEV1), and calculate percentage of the first 1 second forced expiratory volume to FVC (FEV1%); (5) by blood gas analyzer Determination of arterial blood in patients with PH value, partial pressure of oxygen (P02), carbon dioxide partial pressure (PC02); (6) hospital day(HOD). Based on mild: FEV1 / FVC <70%, FEV1≥80% expected value, with or without chronic cough and expectoration symptoms; severe: FEV1 / FVC <70%, FEV1 <30% expected value, or FEV1 <50% expected value, and with chronic respiratory failure or clinical manifestations of right heart failure, chronic obstructive pulmonary disease will be divided into mild and severe groups, the comparative analysis of its nutrition, immunization, lung function and blood gas situation.Results: The actual body weight accounted for the percentage of ideal body weight (% IBW), forced expiratory volume in one second (FEV1) and FEV1 to forced vital capacity (FVC) percentage,rterial carbon dioxide partial pressure (PCO2),hospital day (HOD)between the two groups were significantly different (P <0.05).Conclusion: 1. COPD is a high incidence of common, frequently-occurring disease, and is often accompanied by malnutrition, in the acute stage due to nutrient digestion and absorption barriers, reducing consumption and increasing consumption, malnutrition is more serious.2. Chronic obstructive pulmonary disease patients with the nutritional status of their cellular immune function and respiratory muscle strength and severity of disease are closely related, with the airway resistance in patients with the progressive increase in respiratory muscle must accompanied by the respiratory function improve, that is easy, following energy consumption , heat demand for a more timely manner to the corresponding supplement, together with the causes of hypoxia, such as aggravated respiratory muscle deterioration in energy metabolism, resulting in negative energy balance, thus affecting the prognosis.3. Acute exacerbation of COPD patients with timely and effective nutritional intervention can improve the patient’s immune function and ventilation, and reduce mortality in patients.更多还原