陈娟红　刘景全　许金燕浙江省人民医院ICU，浙江杭州　310014

新斯的明足三里注射在AECOPD机械通气患者早期肠内营养联合应用中的效果评价

陈娟红刘景全许金燕
浙江省人民医院ICU，浙江杭州310014

目的探讨新斯的明足三里注射联合早期肠内营养（EEN）对AECOPD机械通气患者救治的效果。方法将48例AECOPD机械通气患者按随机数字表法分为EEN组和EEN+新斯的明组，每组24例。两组均予以等热量、等氮量的肠内营养（EN）支持，EEN+新斯的明组同时行双侧足三里穴注射新斯的明。分别于EN支持前及EN支持开始后第7、14天检测血清前白蛋白（PALB）、血红蛋白（Hb）、肱三头肌皮褶厚度（TSF）、上臂肌围（MAMC）、氮平衡（NB）；记录EN使用期间达完全肠内营养（TEN）时间、血气指标、脱机成功率、EN相关并发症的发生率和相关预后指标。 结果EN治疗后各营养指标均较治疗前改善，且EEN+新斯的明组7 d时PALB、NB以及14 d时PALB、TSF、NB改善均明显优于EEN组（P＜0.05）；EEN+新斯的明组较单纯EEN组脱机成功率有所提高（62.50% vs 41.67%，P＜0.05），EN耐受性显著增强［（5.8±0.7）d vs（7.7±1.3）d，P＜0.05］，且EN相关并发症发生率明显降低；EEN+新斯的明组较单纯EEN患者机械通气时间缩短（P＜0.05）。结论 EEN支持联合新斯的明足三里注射能改善AECOPD有创机械通气患者营养状态，增强患者对EN耐受、降低EN相关并发症、缩短机械通气时间及提高脱机成功率。

慢性阻塞性肺病急性加重；机械通气；早期肠内营养；新斯的明；足三里

［Abstract］Objective To investigate the effectiveness of combination of tsusanli injection of neostigmine and early enteral nutrition（EEN）in the patients with AECOPD mechanical ventilation.Methods 48 patients with AECOPD mechanical ventilation were divided into EEN group and EEN+neostigmine group according to the random number table with 24 cases in each group.Patients from both groups were given isocaloric and isonitrogenous enteral nutrition（EN）support while patients of EEN+neostigmine group were concurrently given bilateral tsusanli injection of neostigmine.The levels of serum PALB，Hb，TSF，MAMC and NB before the EN support and at the 7th and 14th days after the EN support were examined；the time of reaching TEN，blood gas，successive rate of weaning from mechanical ventilation，incidence rate of EEN related complications and the related prognostic indexes were recorded.Results The nutritional indexes after EN treatment were all improved than those before the treatment and the improvement of PALB，NB at 7 d and PALB，TSF，NB at 14 d of EEN+neostigmine group were significantly obvious than the simple EEN group（P＜0.05）；the successive rate of weaning of mechanical ventilation of EEN+neostigmine group was higher than the EEN group（62.50% vs 41.67%，P＜0.05），the EN tolerance was strengthened significantly［（5.8±0.7）d vs（7.7±1.3）d，P＜0.05］，and the incidence rate of EEN related complications was obviously decreased；the endurance of mechanical ventilation of patients from EEN+neostigmine group was shortened compared to the patients from the simple EEN group（P＜0.05）.Conclusion Combination of EEN support and tsusanli injection of neostigmine can improve nutritional statues of patients with AECOPD traumatic mechanical ventilation，strengthen EN tolerance，decrease the incidence rate of EEN related complications，shorten the endurance of mechanical ventilation and increase the successive rate of weaning of mechanical ventilation.

［Key words］Acute exacerbation of chronic obstructive pulmonary disease；Mechanical ventilation；Early enteral nutrition；Neostigmine；Tsusanli

慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）机械通气患者普遍存在营养不良，早期肠内营养（enteral nutritiona，EN）支持治疗可以缩短机械通气时间、缩短ICU住院时间及改善临床预后［1，2］。由于慢性阻塞性肺疾病急性加……