谷氨酰胺肠外营养对创伤后多器官衰竭患者的营养作用

Nutritional Effects of Glutamine-enriched Parenteral Nutrition on Multiple Organ Failure after Trauma

目的探讨补充谷氨酰胺(Gln)的肠外营养在严重创伤后多器官衰竭(MOF)患者治疗中的作用。方法采用随机对照方法,将60例MOF患者分为Gln组和对照组,每组30例。Gln组给予Gln1.5ml/kg联合常规治疗[热量104～125kJ/(kg·d),其中脂肪供热40%,氮供给量为0.2～0.25g/(kg·d)的完全胃肠外营养(TPN)支持];对照组仅给予常规治疗,连续7d。对照分析营养指标、免疫指标、并发症及临床结果。结果所有患者营养指标(血清白蛋白、前清蛋白、转铁蛋白)和免疫指标(IgG、IgA、IgM)明显减低,处于负氮平衡。第8天时,Gln组营养指标明显高于治疗前及对照组(P<0.05),负氮平衡得到纠正(P<0.05),而对照组仅血清白蛋白、转铁蛋白较治疗前增高(P<0.05),仍处于负氮平衡(P>0.05)。Gln组免疫指标明显高于治疗前及对照组(P<0.01),而对照组仅IgG高于治疗前(P<0.01)。对照组14例(46.7%)出现了血清胆红素、丙氨酸转氨酶和血糖的升高,而Gln组仅4例(13.3%)增高(P<0.05),至14d时对照组病死率为36.7%,而Gln组仅为10%,两者相比差异有显著性(P<0.05)。结论应用Gln的肠外营养能够明显纠正MOF患者的营养代谢障碍,纠正负氮平衡,增强免疫功能,降低并发症及病死率。

Objective To investigate the effects of glutamine(Gln)-enriched total parenteral nutrition(TPN)on multiple organ failure(MOF)after trauma. Methods Sixty MOF patients were included in a randomized controlled clinical trial,and divided into Gln group and control group,with 30 cases for each. Patients in both groups received standard treatment. In the Gln group,total calories were supplied in an amount of 104 - 125 kJ/(kg·d). Lipid calorie was in a rate of supplied 40% of the total calorie value. In addition,with 1.5 ml/kg Glu daily was added to Gln group from day 1 to day 7. Serum albumin,proal-bumin,transferin,nitrogen balance,IgA,IgG,and IgM were determined respectively on day 1,5,and 8 after treatment. Clinical conditions,sugar,liver function were also monitored. Results Serum albumin,proalbumin,transferin,IgA,IgG,and IgM were decreased in all patients. Albumin,proalbumin,trans-ferrin,IgA,IgG,IgM,and negative nitrogen balance were significantly improved in Gln group at day 8 compared with control and before treatment(P < 0.05),while in control group,only serum albumin,transferin,and IgG were improved compared with before treatment(P < 0.05). The incidence of compli-cations was significantly lower in Gln group than in control group(13.3% vs 46.7%,P < 0.05). Conclusion Glutamine-enriched parenteral nutrition support can significantly improve the clinical con-ditions and decrease the incidence of complications.