补充含有谷氨酰胺的肠外营养对危重病人6个月预后的研究

Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition

作为人体内最丰富的氨基酸 ,谷氨酰胺 (Gln)具有许多重要的代谢作用 ,能够维持和改善组织的完整性和促进机体的免疫功能。危重病人的血浆和组织中的谷氨酰胺都是下降的 ,说明这些病人对谷氨酰胺的需要量超过了内源性谷氨酰胺的供给量。 目的 危重病人谷氨酰胺的相对缺乏将会影响到病人的恢复和延长疾病的时间并可能增加病人后期死亡率。本研究将检验这个假说。 方法 在本研究中 ,我们采用前瞻、块随机和双盲设计 ,研究与传统的等氮、等热卡的肠外营养相比 ,观察给予含有谷氨酰胺的肠外营养是否影响病人的预后 ,研究指标采用 6个月的患病率、死亡率和费用情况。在同一个普通的ICU进行研究 ,保证治疗和处理的一致性。 84例危重成年病人进入研究 ,他们的APACHE评分 >10 ,因为他们有肠内营养的禁忌症或肠内营养不成功 ,他们都接受肠外营养。 结果 接受含谷氨酰胺肠外营养组病人的 6个月存活率明显改善 (2 4/ 42比 14/ 42 ,P =0 0 49)。需要接受不含谷氨酰胺的肠外营养超过 10天的病人死亡数明显较多 (P =0 0 3)。对照组病人死亡多发生在疾病后期 ,病人在给予治疗后住ICU时间明显较长 (P =0 .0 12 )。接受谷氨酰胺的病人 ,每例存活者总的ICU费用和总住院费用下降 5 0 %。 结论 对不能接受肠内营养?

An abundant amino acid in the human body,glutamine (Gln) has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system.Low plasma and tissue levels of Gln in the critically ill suggest that demand may exceed endogenous supply.A relative deficiency of Gln in such patients could compromise recovery and result in prolonged illness and an increase in late mortality.This study examines this hypothesis.Using a prospective,block-randomized,double-blind treatment study design,we tested whether a Gln-containing parenteral nutrition (PN) compared with an isonitrogenous,isoenergetic control feed would influence outcome,with the endpoints of morbidity,mortality,and cost at 6 mo postintervention.In one general intensive care unit (ICU),to ensure consistency of management policies,84 critically ill adult patients,with Acute Physiological and Chronic Health Evaluation Ⅱ score>10,requiring nutritional support received PN only if enteral nutrition was contraindicated or unsuccessful.Survival at 6 mo was significantly improved in those receiving Gln PN (24/42 versus 14/42; P =0.049).Significantly more deaths occurred in patients requiring control PN for > 10d ( P =0.03).The excess control deaths occurred later and those patients had had a significantly longer postintervention stay ( P =0.012) and use of ICU.In the Gln recipients,the total ICU and hospital cost per survivor was reduced by 50%.In critically ill ICU patients unable to receive enteral nutrition,a Gln-containing PN solution improves survival at 6 mo and reduces the hosptial costs per survivor.