谷氨酰胺肠外营养对危重病患者的营养作用

Nutritional effects of glutamine-enriched parenteral nutrition in critical patients

目的评估肠外谷氨酰胺(Gln)对危重患者营养状况、炎症反应及免疫功能的影响。方法60例ICU危重患者中,Gln组30例给予肠外营养及Gln,对照组30例仅给予肠外营养,支持8d后,观察营养指标(血清白蛋白、前白蛋白、转铁蛋白)、炎症反应(CPR、IL6、TNFα)及免疫功能指标(IgG、IgA、IgM)变化。结果(1)两组支持前营养指标和免疫指标明显减低,第8天时Gln组指标明显高于治疗前及对照组(P<0.05)。(2)两组患者炎性反应指标均明显升高,营养支持后Gln组较对照组降低(P<0.05)。(3)营养支持后出现不同程度肝功能异常和高血糖,对照组有13例(43.3%),Gln组5例(16.7%)(P<0.05);至14d时对照组死亡5例(16.7%),而Gln组2例(6.7%)(P>0.05)。结论重症患者使用肠外谷氨酰胺有助于强化肠外营养支持效果,减轻炎症反应,提高机体免疫力。

Objective To evaluate the influence of glutamine（Gln）-enriched total parenteral nutrition on nutritional status,suppression of excessive systematic inflammatory responses and immunological competence on critical patients in ICU. Methods Sixty critical patients were included in a randomized controlled clinical trial and divided into Gin group and control group, with 30 case for each group. Both groups received isocaloric and isonitrogenous nutritional formulas on everyday. In addition, Gin was added to Gin group from day 1 to day 8. On day 1 and 8 after treatment,serum albumin, proalbumin,transferin, IgA, IgG and IgM were determined respectively. The plasma level of CPR, IL-6, TNF-α, blood suger, liver function were also monitored. Results （ 1 ） The level of serum albumin, proalbumin,transferin, IgA, IgG, and IgM decreased in all patients. Albumin, proalbumin, transferin, IgA, IgG, and IgM were significantly improved in Gin group on day 8 compared with control group and before treatment （P 〈 0.05）. （2）The serum level of CRP, IL-6, and TNF-α was significantly high before treatment in both groups. In Gin group, however, significantly less CRP, IL-6, and TNF-αproduction was observed on day 8 （ P 〈 0.05 ）. （3） The incidence of complications was significantly lower in Gin group than in control group （ 16.7 % vs 46.3 %, P 〈 0.05）. Conclusion Glutamine-enriched parenteral nutrition support can significantly improve the clinical conditions and decrease the incidence of complications.