慢性阻塞性肺疾病急性加重期患者营养风险与ICU获得性衰弱的相关性-现代医学

慢性阻塞性肺疾病急性加重期患者营养风险与ICU获得性衰弱的相关性

单位：上海市公共卫生临床中心急诊科, 上海 201508

分类号：R256

出版年·卷·期（页码）：2025·53·第十二期（1908-1914）

摘要：

目的：探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者营养风险与重症监护室获得性衰弱(ICU-AW)的相关性，为ICU-AW的临床预防管理提供依据。方法：选取2023年8月至2024年12月期间上海市公共卫生临床中心急诊重症监护室(EICU)收治并接受机械通气的178例AECOPD患者为研究对象，入院第1天采用营养风险筛查2002(NRS-2002)量表评估营养风险，以评分≥3分为高营养风险组，<3分为低营养风险组；接受机械通气的7 d内，利用医学研究委员会肌力总分(MRC-SS)评估肌力并统计ICU-AW发生率。依据ICU-AW发生情况将研究对象分成ICU-AW组和对照组。采用单因素和多因素Logistic回归分析AECOPD患者发生ICU-AW的影响因素，并绘制不同营养风险亚组的Kaplan-Meier(K-M)生存曲线。结果：高营养风险占比55.06%(98/178)，ICU-AW发生率为42.13%(75/178)。ICU-AW组年龄、合并糖尿病、急性生理学与健康状况评分Ⅱ(APACHE Ⅱ评分)、机械通气时间、使用糖皮质激素药物、肠内营养喂养不耐受(FI)及高营养风险占比均高于对照组(均P＜0.05)。多因素分析显示，年龄、糖尿病史、APACHE Ⅱ评分、机械通气时间、使用糖皮质激素药物、肠内营养FI、高营养风险均是AECOPD患者发生ICU-AW的独立影响因素(均P＜0.05)。K-M生存曲线显示高营养风险组ICU-AW发生率高于低营养风险组(Log-Rank χ²=6.130，P＜0.05)。结论： AECOPD患者的营养风险状况与ICU-AW发生密切相关，高营养风险者面临更高的ICU-AW发生风险。

Objective: To explore the correlation between nutritional risk and ICU-acquired weakness(ICU-AW) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), providing a basis for the clinical prevention and management of ICU-AW. Methods: A total of 178 AECOPD patients who were admitted to the emergency intensive care unit(EICU) of Shanghai public health clinical center from August 2023 to December 2024 and received mechanical ventilation were selected as the study subjects. On the first day of admission, the nutritional risk screening 2002(NRS-2002) was used to assess the nutritional risk of the subjects, who were divided into a high nutritional risk group(NRS-2002 score ≥3) and a low nutritional risk group(score＜3). Within 7 days of mechanical ventilation, the medical research council sum score(MRC-SS) was used to assess muscle strength and record the incidence of ICU-acquired weakness(ICU-AW). Based on the occurrence of ICU-AW, the subjects were divided into an ICU-AW group and a control group. Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of ICU-AW in AECOPD patients, and Kaplan-Meier(K-M) survival curves were plotted for different nutritional risk subgroups. Results: The proportion of patients with high nutritional risk was 55.06%(98/178), and the overall incidence of ICU-AW was 42.13%(75/178). Compared with the control group, the ICU-AW group had significantly higher values or proportions for age, comorbid diabetes, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, duration of mechanical ventilation, use of glucocorticoids, feeding intolerance(FI) during enteral nutrition, and high nutritional risk(all P<0.05). Multivariate logistic regression analysis showed that older age, history of diabetes, higher APACHE Ⅱscore, longer mechanical ventilation duration, glucocorticoid use, enteral nutrition-related FI, and high nutritional risk were all independent risk factors for ICU-AW in AECOPD patients(all P<0.05). The K-M survival curve demonstrated a significantly higher cumulative incidence of ICU-AW in the high-nutritional-risk group than in the low-nutritional-risk group(Log-rank χ²=6.130, P<0.05). Conclusion: Nutritional risk status of patients with AECOPD is closely related to the occurrence of ICU-AW. Those with high nutritional risk face a higher risk of ICU-AW occurrence.

参考文献：

[1] MACLEOD M,PAPI A,CONTOLI M,et al.Chronic obstructive pulmonary disease exacerbation fundamentals:diagnosis,treatment,prevention and disease impact[J].Respirology,2021,26(6):532-551.
[2] 孔梅,李玉伶,张巧梅,等.危重症患者ICU获得性衰弱护理干预现状[J].天津护理,2023,31(5):618-621.
[3] 郑卉,史源,张钊龙,等.ICU获得性衰弱的研究进展[J].中华危重病急救医学,2024,36(3):308-312.
[4] OTHMAN S Y,ELBIAA M A,MANSOUR E R,et al.Effect of neuromuscular electrical stimulation and early physical activity on ICU-acquired weakness in mechanically ventilated patients:a randomized controlled trial[J].Nurs Crit Care,2024,29(3):584-596.
[5] 戴罕之,张胜,林荣海.危重症患者营养治疗途径的研究进展[J].实用医学杂志,2024,40(4):585-590.
[6] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.慢性阻塞性肺疾病基层诊疗指南(2018年)[J].中华全科医师杂志,2018,17(11):856-870.
[7] 吴文晓,张佩君,郎萍,等.呼吸内科肺部感染住院患者营养风险筛查[J].中华医院感染学杂志,2020,30(17):2632-2636.
[8] 吴雨晨,丁楠楠,姜变通,等.ICU获得性肌无力患者功能评估的系统评价[J].中华危重病急救医学,2018,30(12):1154-1160.
[9] LEE Y T,WANG C C,LI C F,et al.Utility of acute physiology and chronic health evaluation(APACHE Ⅱ) in predicting mortality in patients with pyogenic liver abscess:a retrospective study[J].J Clin Med,2021,10(12):264.
[10] 王凌伟,陈荣昌.基层慢阻肺早期筛查和早期诊断的现状与对策[J].中华健康管理学杂志,2022,16(4):217-221.
[11] 何雯青,王佳佳,谢洋,等.慢性阻塞性肺疾病疾病负担测评方法概述[J].中国卫生经济,2024,43(2):58-61.
[12] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组,《慢性阻塞性肺疾病合并心血管疾病诊治管理专家共识》撰写组.慢性阻塞性肺疾病合并心血管疾病诊治管理专家共识[J].中华结核和呼吸杂志,2022,45(12):1180-1191.
[13] 中华医学会呼吸病学分会,中华预防医学会呼吸病预防与控制专业委员会,中国医师协会呼吸医师分会,等.慢性阻塞性肺疾病急性加重围出院期管理与随访指南(2024年版)[J].中华结核和呼吸杂志,2024,47(11):1048-1068.
[14] 陈典,隆寰宇,张丛溪,等.2025年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J].中国全科医学,2025,28(16):1937-1949.
[15] 程敏,刘芹,甘皓月,等.不同干预措施对ICU获得性衰弱患者应用效果的网状Meta分析[J].现代医学,2024,52(6):884-891.
[16] WANG M,GUO Q,LIU H,et al.GLIM criteria using NRS-2002 and MUST as the first step adequately diagnose the malnutrition in Crohn's disease inpatients:a retrospective study[J].Front Nutr,2023,9:1059191.
[17] 赵红星,王同.老年慢性阻塞性肺疾病急性加重期住院患者营养风险的调查分析[J].中华老年多器官疾病杂志,2021,20(9):674-677.
[18] 赵航,杜敏,曾庆萃,等.ICU获得性衰弱防治进展[J].四川医学,2023,44(11):1201-1205.
[19] 赵秋芬,周兴婷,谢霖,等.营养风险筛查工具对神经系统危重症患者ICU获得性衰弱的预测研究[J].医学理论与实践,2024,37(24):4154-4157.
[20] 侯芳,高晶,赵瑞玲,等.肠内营养喂养不耐受与慢阻肺急性加重期机械通气患者并发ICU获得性衰弱的相关性研究[J].临床肺科杂志,2022,27(1):36-40
[21] 苏丽,张霞,张莉,等.行动研究法对慢阻肺患者机械通气后获得性衰弱的干预作用研究[J].临床肺科杂志,2020,25(2):223-226.
[22] 窦露,刘畅,杨致昊,等.动物肌肉组织蛋白质代谢调控的研究进展[J].动物营养学报,2022,34(1):39-50.
[23] HAN H,HU S,DU J.Predictive value of the hemoglobin-albumin-lymphocyte-platelet(HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) [J].Intern Emerg Med,2023,18(1):85-96.
[24] LI Y,XIE Y P,LI X M,et al.Effects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation[J].World J Emerg Med,2023,14(3):193-197.

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