目的 观察和比较单纯肠内营养(EN)、单纯肠外营养(PN)、肠内肠外联合营养(EN+ PN)3种营养支持方式对高龄顽固性心力衰竭患者近期结局的影响及其安全性.方法 选取2004年1月至2012年9月在北京军区总医院263临床部住院的247例高龄顽固性心力衰竭患者,采用随机数字表法分为EN+ PN组(n=87)、EN组(n=76)、PN组(n=84).随机分组后根据患者耐受情况,EN组2例转入EN+ PN组,PN组3例转入EN+ PN组.于营养支持前和营养支持7d后检测血清学指标和心脏超声血液动力学指标,根据全身症状计算营养支持后好转率,记录不良事件发生情况进行安全性评价.结果 研究过程中共8例患者退出,其中EN组4例,PN组1例,EN+ PN组3例.与营养支持前比较,各组营养支持7d后血清前白蛋白[EN组,(0.17 ±0.01) g/L比(0.11 ±0.02) g/L; PN组,(0.19±0.01) g/L比(0.09±0.02) g/L; EN+PN组,(0.24±0.04) g/L比(0.10±0.02) g/L]、白蛋白[EN组,(34.14±1.00)g/L比(31.25±1.02)g/L; PN组,(33.89±1.20) g/L比(30.99±1.07) g/L; EN+PN组,(36.66±1.36) g/L比(31.00±1.01) g/L]、转铁蛋白[EN组, (1.99±0.39) g/L比(1.86±0.36) g/L; PN组, (2.01±0.41)g/L比(1.89±0.34) g/L; EN+PN组, (2.58±0.47) g/L比(1.92±0.33) g/L]均显著升高(P均=0.008)；EN+ PN组的前白蛋白(P=0.007、0.008)、白蛋白(P =0.041、0.040)、转铁蛋白(P=0.007、0.008)均显著高于EN组和PN组.PN组营养支持后血糖显著升高[(8.06±2.35) mmol/L比(5.81±2.21) mmol/L,P=0.009],其余两组营养支持前后差异无统计学意义.与营养支持前比较,3组营养支持7d后每搏输出量(SV) [EN组,(60.91±7.26) ml比(45.09±6.42) ml;PN组,(61.01±7.29) ml比(45.19±6.39) ml; EN +PN组, (65.42±7.43) ml比(46.11±6.41) ml;P均=0.008]、左心室射血分数(LVEF)[EN组,(45.78±0.09)％比(34.61±0.09)％; PN组,(45.11±0.11)％比(34.55±0.08)％；EN+PN组,(49.79±0.11)％比(34.42±0.09)％；P均=0.008]、左心室舒张末期内径(LVEdd) [EN组,(60.22±2.42) mm比(63.20±2.19) mm,P=0.008; PN组,(60.28±2.44) mm比(62.98±2.11) mm,P=0.044; EN+PN组,(57.43±2.40) mm比(63.09±2.08) mm,P=0.008]、左心室收缩末期内径(LVEsd)[EN组,(54.08±6.06) mm比(56.15±6.03) mm,P=0.044; PN组, (54.42±6.10) mm比(56.31±6.11) mm,P=0.044;EN+ PN组, (51.48±5.27)mm比(56.32±6.13) mm,P=0.008]均明显改善；EN+ PN组的SV (P=0.003、0.004)和LVEF(P均=0.004)均显著大于EN组和PN组,LVEdd (P=0.004、0.005)和LVEsd(P=0.004、0.005)均显著小于EN组和PN组.EN组、PN组、EN+ PN组的好转率分别为75.71％ (53/70)、75.00％ (60/80)、83.15％ (74/89),异常状况评分与营养支持前比较均显著改善(P均=0.000)；EN+ PN组的好转率显著高于EN组和PN组(P均=0.005),PN组与EN组的好转率差异无统计学意义(P=0.059).PN组的恶化率为15.00％,明显高于EN组(12.85％,P=0.048)和EN+ PN组(6.74％,P=0.045).营养支持期间EN+ PN组不良事件发生率显著低于EN组[22.47％ (20/89)比37.14％ (26/70),P=0.005],与PN组比较差异无统计学意义[35.00％ (28/80),P=0.057].结论 对于高龄顽固性心力衰竭患者,EN+PN可提高血清前白蛋白、白蛋白、转铁蛋白水平,缓解临床症状,改善血液动力学,且不良事件发生率较低,是优于单纯EN或PN的营养支持方式.
目的 觀察和比較單純腸內營養(EN)、單純腸外營養(PN)、腸內腸外聯閤營養(EN+ PN)3種營養支持方式對高齡頑固性心力衰竭患者近期結跼的影響及其安全性.方法 選取2004年1月至2012年9月在北京軍區總醫院263臨床部住院的247例高齡頑固性心力衰竭患者,採用隨機數字錶法分為EN+ PN組(n=87)、EN組(n=76)、PN組(n=84).隨機分組後根據患者耐受情況,EN組2例轉入EN+ PN組,PN組3例轉入EN+ PN組.于營養支持前和營養支持7d後檢測血清學指標和心髒超聲血液動力學指標,根據全身癥狀計算營養支持後好轉率,記錄不良事件髮生情況進行安全性評價.結果 研究過程中共8例患者退齣,其中EN組4例,PN組1例,EN+ PN組3例.與營養支持前比較,各組營養支持7d後血清前白蛋白[EN組,(0.17 ±0.01) g/L比(0.11 ±0.02) g/L; PN組,(0.19±0.01) g/L比(0.09±0.02) g/L; EN+PN組,(0.24±0.04) g/L比(0.10±0.02) g/L]、白蛋白[EN組,(34.14±1.00)g/L比(31.25±1.02)g/L; PN組,(33.89±1.20) g/L比(30.99±1.07) g/L; EN+PN組,(36.66±1.36) g/L比(31.00±1.01) g/L]、轉鐵蛋白[EN組, (1.99±0.39) g/L比(1.86±0.36) g/L; PN組, (2.01±0.41)g/L比(1.89±0.34) g/L; EN+PN組, (2.58±0.47) g/L比(1.92±0.33) g/L]均顯著升高(P均=0.008)；EN+ PN組的前白蛋白(P=0.007、0.008)、白蛋白(P =0.041、0.040)、轉鐵蛋白(P=0.007、0.008)均顯著高于EN組和PN組.PN組營養支持後血糖顯著升高[(8.06±2.35) mmol/L比(5.81±2.21) mmol/L,P=0.009],其餘兩組營養支持前後差異無統計學意義.與營養支持前比較,3組營養支持7d後每搏輸齣量(SV) [EN組,(60.91±7.26) ml比(45.09±6.42) ml;PN組,(61.01±7.29) ml比(45.19±6.39) ml; EN +PN組, (65.42±7.43) ml比(46.11±6.41) ml;P均=0.008]、左心室射血分數(LVEF)[EN組,(45.78±0.09)％比(34.61±0.09)％; PN組,(45.11±0.11)％比(34.55±0.08)％；EN+PN組,(49.79±0.11)％比(34.42±0.09)％；P均=0.008]、左心室舒張末期內徑(LVEdd) [EN組,(60.22±2.42) mm比(63.20±2.19) mm,P=0.008; PN組,(60.28±2.44) mm比(62.98±2.11) mm,P=0.044; EN+PN組,(57.43±2.40) mm比(63.09±2.08) mm,P=0.008]、左心室收縮末期內徑(LVEsd)[EN組,(54.08±6.06) mm比(56.15±6.03) mm,P=0.044; PN組, (54.42±6.10) mm比(56.31±6.11) mm,P=0.044;EN+ PN組, (51.48±5.27)mm比(56.32±6.13) mm,P=0.008]均明顯改善；EN+ PN組的SV (P=0.003、0.004)和LVEF(P均=0.004)均顯著大于EN組和PN組,LVEdd (P=0.004、0.005)和LVEsd(P=0.004、0.005)均顯著小于EN組和PN組.EN組、PN組、EN+ PN組的好轉率分彆為75.71％ (53/70)、75.00％ (60/80)、83.15％ (74/89),異常狀況評分與營養支持前比較均顯著改善(P均=0.000)；EN+ PN組的好轉率顯著高于EN組和PN組(P均=0.005),PN組與EN組的好轉率差異無統計學意義(P=0.059).PN組的噁化率為15.00％,明顯高于EN組(12.85％,P=0.048)和EN+ PN組(6.74％,P=0.045).營養支持期間EN+ PN組不良事件髮生率顯著低于EN組[22.47％ (20/89)比37.14％ (26/70),P=0.005],與PN組比較差異無統計學意義[35.00％ (28/80),P=0.057].結論 對于高齡頑固性心力衰竭患者,EN+PN可提高血清前白蛋白、白蛋白、轉鐵蛋白水平,緩解臨床癥狀,改善血液動力學,且不良事件髮生率較低,是優于單純EN或PN的營養支持方式.
목적 관찰화비교단순장내영양(EN)、단순장외영양(PN)、장내장외연합영양(EN+ PN)3충영양지지방식대고령완고성심력쇠갈환자근기결국적영향급기안전성.방법 선취2004년1월지2012년9월재북경군구총의원263림상부주원적247례고령완고성심력쇠갈환자,채용수궤수자표법분위EN+ PN조(n=87)、EN조(n=76)、PN조(n=84).수궤분조후근거환자내수정황,EN조2례전입EN+ PN조,PN조3례전입EN+ PN조.우영양지지전화영양지지7d후검측혈청학지표화심장초성혈액동역학지표,근거전신증상계산영양지지후호전솔,기록불량사건발생정황진행안전성평개.결과 연구과정중공8례환자퇴출,기중EN조4례,PN조1례,EN+ PN조3례.여영양지지전비교,각조영양지지7d후혈청전백단백[EN조,(0.17 ±0.01) g/L비(0.11 ±0.02) g/L; PN조,(0.19±0.01) g/L비(0.09±0.02) g/L; EN+PN조,(0.24±0.04) g/L비(0.10±0.02) g/L]、백단백[EN조,(34.14±1.00)g/L비(31.25±1.02)g/L; PN조,(33.89±1.20) g/L비(30.99±1.07) g/L; EN+PN조,(36.66±1.36) g/L비(31.00±1.01) g/L]、전철단백[EN조, (1.99±0.39) g/L비(1.86±0.36) g/L; PN조, (2.01±0.41)g/L비(1.89±0.34) g/L; EN+PN조, (2.58±0.47) g/L비(1.92±0.33) g/L]균현저승고(P균=0.008)；EN+ PN조적전백단백(P=0.007、0.008)、백단백(P =0.041、0.040)、전철단백(P=0.007、0.008)균현저고우EN조화PN조.PN조영양지지후혈당현저승고[(8.06±2.35) mmol/L비(5.81±2.21) mmol/L,P=0.009],기여량조영양지지전후차이무통계학의의.여영양지지전비교,3조영양지지7d후매박수출량(SV) [EN조,(60.91±7.26) ml비(45.09±6.42) ml;PN조,(61.01±7.29) ml비(45.19±6.39) ml; EN +PN조, (65.42±7.43) ml비(46.11±6.41) ml;P균=0.008]、좌심실사혈분수(LVEF)[EN조,(45.78±0.09)％비(34.61±0.09)％; PN조,(45.11±0.11)％비(34.55±0.08)％；EN+PN조,(49.79±0.11)％비(34.42±0.09)％；P균=0.008]、좌심실서장말기내경(LVEdd) [EN조,(60.22±2.42) mm비(63.20±2.19) mm,P=0.008; PN조,(60.28±2.44) mm비(62.98±2.11) mm,P=0.044; EN+PN조,(57.43±2.40) mm비(63.09±2.08) mm,P=0.008]、좌심실수축말기내경(LVEsd)[EN조,(54.08±6.06) mm비(56.15±6.03) mm,P=0.044; PN조, (54.42±6.10) mm비(56.31±6.11) mm,P=0.044;EN+ PN조, (51.48±5.27)mm비(56.32±6.13) mm,P=0.008]균명현개선；EN+ PN조적SV (P=0.003、0.004)화LVEF(P균=0.004)균현저대우EN조화PN조,LVEdd (P=0.004、0.005)화LVEsd(P=0.004、0.005)균현저소우EN조화PN조.EN조、PN조、EN+ PN조적호전솔분별위75.71％ (53/70)、75.00％ (60/80)、83.15％ (74/89),이상상황평분여영양지지전비교균현저개선(P균=0.000)；EN+ PN조적호전솔현저고우EN조화PN조(P균=0.005),PN조여EN조적호전솔차이무통계학의의(P=0.059).PN조적악화솔위15.00％,명현고우EN조(12.85％,P=0.048)화EN+ PN조(6.74％,P=0.045).영양지지기간EN+ PN조불량사건발생솔현저저우EN조[22.47％ (20/89)비37.14％ (26/70),P=0.005],여PN조비교차이무통계학의의[35.00％ (28/80),P=0.057].결론 대우고령완고성심력쇠갈환자,EN+PN가제고혈청전백단백、백단백、전철단백수평,완해림상증상,개선혈액동역학,차불량사건발생솔교저,시우우단순EN혹PN적영양지지방식.
Objective To explore and compare the efficacy and safety of enteral nutrition (EN),parenteral nutrition (PN),and EN + PN nutrition support on short-term outcomes of elderly patients with refractory heart failure.Methods From January 2004 to September 2012,247 elderly patients with refractory heart failure were admitted in NO.263 Clinical Department of Military General Hospital of Beijing PLA.The patients were allocated into 3 groups with random number table:the EN + PN group (n =87),the EN group (n =76),and the PN group (n =84).According to the toleration of patients to nutrition supports,5 cases were transferred to the EN + PN group,including 2 from the EN group and 3 from the PN group.The safety was assessed based on the improvement of systemic symptoms,the occurrence of adverse events,and the efficacy assessed based on serological and echocardiographic hemodynamic indexes detected before the nutrition therapy and after 7-day's nutrition support.Results Eight patients withdrew from the study,including 4 from the EN group,1from the PN group,and 3 from the EN + PN group.Compared with the levels before nutrition,serum prealbumin (PA) [EN group,(0.17 ±0.01) g/L vs.(0.11 ±0.02) g/L; PN group,(0.19 ±0.01) g/L vs.(0.09 ±0.02) g/L; EN+PN group,(0.24 ±0.04) g/L vs.(0.10 ±0.02) g/L],albumin (ALB) [EN group,(34.14 ± 1.00) g/L vs.(31.25 ± 1.02) g/L; PN group,(33.89 ± 1.20) g/L vs.(30.99 ± 1.07) g/L;EN+PN group,(36.66 ± 1.36) g/L vs.(31.00 ± 1.01) g/L],transferrin (TF) [EN group,(1.99 ±0.39) g/Lvs.(1.86±0.36) g/L;PNgroup,(2.01 ±0.41) g/Lvs.(1.89±0.34) g/L; EN+PNgroup,(2.58 ± 0.47) g/L vs.(1.92 ± 0.33) g/L] of all the 3 groups were significantly increased after nutrition (all P =0.008) ; and compared with the EN and the PN groups,PA (P =0.007 and 0.008),ALB (P =0.041and 0.040),and TF (P =0.007 and 0.008) in the EN + PN group were significantly higher.Only in the PN group,blood glucose significantly increased after nutrition support [(8.06 ± 2.35) mmol/L vs.(5.81 ±2.21) mmol/L,P=0.009].In all the 3 groups,stroke volume (SV) [EN group,(60.91 ±7.26) ml vs.(45.09±6.42) ml; PN group,(61.01 ±7.29) rml vs.(45.19 ±6.39) ml; EN +PN group,(65.42 ±7.43) ml vs.(46.11 ± 6.41) ml; all P =0.008],left ventricular ejection fraction (LVEF) [EN group,(45.78 ±0.09)％ vs.(34.61 ±0.09)％; PN group,(45.11 ±0.11)％ vs.(34.55 ±0.08)％; EN+PN group,(49.79 ± 0.11) ％ vs.(34.42 ± 0.09％ ; all P =0.008],left ventricular end-diastolic diameter (LVEdd) [EN group,(60.22 ±2.42) mm vs.(63.20 ±2.19) mm,P =0.008; PN group,(60.28 ±2.44) mmvs.(62.98 ± 2.11) mm,P=0.044; EN + PN group,(57.43 ± 2.40) mm vs.(63.09 ±2.08) mm,P =0.008],left ventricular end-systolic diameter (LVEsd) [EN group,(54.08 ± 6.06) mm vs.(56.15 ±6.03) mm,P=0.044; PNgroup,(54.42 ±6.10) mmvs.(56.31 ±6.11) mm,P=0.044;EN + PN group,(51.48 ± 5.27) mm vs.(56.32 ± 6.13) mm,P =0.008] were significantly improved after nutrition support ; compared with the EN group and the PN group,SV (P =0.003 and 0.004) and LVEF(both P =0.004) in the EN + PN group were significantly higher,while LVEdd (P =0.004 and 0.005) and LVEsd (P =0.004 and 0.005) were significantly lower.After 7-day's nutrition support,the improvement rate in EN group,PN group,and EN + PN group was 75.71％ (53/70),75.00％ (60/80),and 83.15％ (74/89),respectively.The abnormal sign scores in the 3 groups were all statistically reduced after nutrition (all P =0.000).The improvement rate in EN + PN group was higher than those in EN group and PN group (both P =0.005),but no difference between EN group and PN group (P =0.059).The degradation rate was 15.00％ in the PN group,significantly higher than those in EN group (12.85％,P =0.048) and EN +PN group (6.74％,P =0.045).During the nutrition support,the incidence of adverse events in EN + PN group was significant lower than in EN group [22.47％ (20/89) vs.37.14％ (26/70),P =0.005],but not significantly different compared with PN group [35.00％ (28/80),P =0.057].Conclusions EN + PN could elevate PA,ALB,and TF levels,alleviate clinical symptoms,and improve hemodynamics in elderly refractory heart failure patients.In addition,it has lower incidence of adverse effects than EN and PN applied alone,thus more safe and effective for these patients.
