CAJ | 학술논문

目的：探讨对具营养不良风险的慢性阻塞性肺疾病( COPD)患者进行营养干预的疗效。方法选择于2008年1月至2012年12月在钦州市第二人民医院住院采用营养风险筛查(NRS)2002评分≥3分而确定为具营养不良风险的患者829例，采用SPSS13.0版软件按随机数字表随机分为对照组(254例)和治疗组(575例)，住院期间患者若胃肠道功能无禁忌证则予胃肠内营养支持，而患者存在胃肠营养禁忌证则采用肠外营养支持。治疗组采用特殊营养素强化治疗，对照组仅采用无添加其他营养素的常规营养治疗，其余治疗方法两组相同。两组患者出院后电话随访3年，并定期进行NRS2002评分，对NRS2002评分≥3分的治疗组出院患者进行营养膳食指导。对照组无任何营养指导措施。随访3年后末次进行NRS2002评分，比较两组3年内急性发作次数、需要机械通气次数、机械通气总时间及死亡率、治疗3年后NRS2002评分。并对现有资料进行多因素Logistic回归分析，了解具营养不良风险的COPD患者死亡危险因素。结果治疗组3年内急性发作次数、需要机械通气次数、机械通气总时间明显优于对照组，治疗组死亡率(0.696%)明显低于对照组(4.724%)，而且治疗前后NRS2002评分与具营养不良风险的COPD患者死亡显著正相关。结论对于具营养不良风险的COPD患者，通过积极的营养干预措施可改善患者营养状况( NRS2002评分降低)，从而增加呼吸肌群的总量改善缺氧状态，提高细胞免疫功能，改善预后。
목적：탐토대구영양불량풍험적만성조새성폐질병( COPD)환자진행영양간예적료효。방법선택우2008년1월지2012년12월재흠주시제이인민의원주원채용영양풍험사사(NRS)2002평분≥3분이학정위구영양불량풍험적환자829례，채용SPSS13.0판연건안수궤수자표수궤분위대조조(254례)화치료조(575례)，주원기간환자약위장도공능무금기증칙여위장내영양지지，이환자존재위장영양금기증칙채용장외영양지지。치료조채용특수영양소강화치료，대조조부채용무첨가기타영양소적상규영양치료，기여치료방법량조상동。량조환자출원후전화수방3년，병정기진행NRS2002평분，대NRS2002평분≥3분적치료조출원환자진행영양선식지도。대조조무임하영양지도조시。수방3년후말차진행NRS2002평분，비교량조3년내급성발작차수、수요궤계통기차수、궤계통기총시간급사망솔、치료3년후NRS2002평분。병대현유자료진행다인소Logistic회귀분석，료해구영양불량풍험적COPD환자사망위험인소。결과치료조3년내급성발작차수、수요궤계통기차수、궤계통기총시간명현우우대조조，치료조사망솔(0.696%)명현저우대조조(4.724%)，이차치료전후NRS2002평분여구영양불량풍험적COPD환자사망현저정상관。결론대우구영양불량풍험적COPD환자，통과적겁적영양간예조시가개선환자영양상황( NRS2002평분강저)，종이증가호흡기군적총량개선결양상태，제고세포면역공능，개선예후。
Objective To exPlore the efficacy of nutritional interVention in Patients with chronic obstructiVe Pulmonary disease (COPD) and malnutrition risks. Methods From Jan. ,2008 to Dec. ,2012,829 COPD Patients with NRS2002 score≥3 in Qinzhou Second PeoPle's HosPital were enrolled in this study. Patients were randomized into control grouP (254 cases) and treatment grouP (575 cases) by random numerical table of SPSS 13. 0 statistic software. Patients without contraindication to enteral nutrition were giVen enteral nutrition suPPort,while those with contraindication to enteral nutrition were giVen Parenteral nutrition suPPort. Patients in the treatment grouP receiVed intensiVe suPPort with fortified nutrition,whereas Patients in the control grouP receiVed routine nutrition treatment. All other treatment methods were the same between the two grouPs. TelePhone follow_uP lasted for 3 years in both grouPs after discharge. Patients in the treatment grouP with NRS2002 score≥3 were giVen guidance on nutrition food intake. No nutrition guide was giVen to the control grouP. Times of acute attack,times and duration of mechanical Ventilation,mortality rate,and NRS2002 score three years after the treatment were comPared between the two grouPs. Data were analyzed by multi_factor Logistic regression analysis to understand the nutritional factors of COPD Patients affecting their mortality rate. Results After 3 years of follow_uP,times of acute attack,times and duration of mechanical Ventilation were lower in the treatment grouP than in the control grouP. Mortality rate was significantly lower in the treatment grouP (0. 696%) than the control grouP (4. 724%). After treatment,NRS2002 score was PositiVely correlated with mortality rate of COPD Patients with malnutrition risks. Conclusion For the COPD Patients with malnutrition risks, actiVe nutritional interVention can imProVe their nutrition status ( lower NRS2002 score) ,increase the number of resPiratory muscles to alleViate anoxia,enhance cellular immune function, and thus imProVe their Prognosis.