谷氨酰胺肠外营养支持对卒中急性期患者康复的影响

Effect of glutamine supplemented parenteral nutrition on the rehabilitation in patients with acute stroke

目的探讨谷氨酰胺对卒中急性期患者神经功能康复的影响。方法按入院顺序将急性卒中患者83例分为谷氨酰胺组(41例)和对照组(42例)。谷氨酰胺组在急性期连续7 d静脉输注丙氨酰-谷氨酰胺20 g/d,随后记录7、14、28 d的神经功能缺损评分及营养学指标,同时记录感染性并发症的发生及持续时间。结果谷氨酰胺组患者在28 d的神经功能缺损评分降低14±6,明显好于对照组10±6,P<0.05。营养学参数评估显示谷氨酰胺组在14 d内血清清蛋白水平、非瘫痪侧上肢肱三头肌皮褶厚度及其肌围分别平均降低(2.1±3.4)g/L、(1.6±0.8)mm、(2.5±1.6)cm,对照组相应结果分别为(3.4±2.7)g/L、(2.6±1.3)mm、(4.8±2.9)cm。谷氨酰胺组感染性并发症的持续时间为(2.3±3.3)d,对照组为(5.6±6.4)d,P<0.05。结论给予卒中急性期患者谷氨酰胺,具有改善神经功能的作用,同时能缩短感染性并发症持续的时间以及降低营养状况的恶化程度。

Objective To investigate the effect of glutamine on the neurological rehabilitation in patients with acute stroke. Methods Eighty-three patients with acute stroke were divided into glutamine group （n =41 ） and control group （n = 42 ） according to the order of admission. Venoclysis of alanylglutamine 20 g/d for 7 days were administered continuously during the acute phase in the glutamine group. Then their scores of neurological deficit and nutritive indexes at day 7, 14, and 28 were recorded. At the same time, the occurrence and duration of infective complications were recorded. Results At day 28 the scores of neurological deficit reduced 14 ± 6 in the glutamine group, and it was significantly better than 10 ± 6 in the control group （P 〈 0. 05 ）. The nutritive parameters evaluation indicated that the level of serum albumin, the triceps skin fold thickness and triceps circumference in the non-paralysis side upper limbs reduced （2. 1 ±3.4） g/L, （ 1.6 ±0. 8） mm, and （2. 5 ± 1.6） cm, respectively at day 14 in the glutamine group; the relative results in the control group were （3.4±2.7） g/ L, （2.6±1.3） mm, and （4.8±2.9） cm, respectively. The duration of the infective complications was （ 2. 3 ± 3.3 ） d in the glutamine group as compared （5.6 ± 6. 4 ） d in the control group （ P 〈 0. 05 ）. Conclusion The administration of glutamine in patients with stroke during the acute phase may have the effect of improving neurological function. At the same time, it may shorten the duration of infective complications and reduce the degrees of deterioration of nutrition status.