特殊配方强化肠外营养支持治疗危重症患者的临床研究

Clinical Study of Intensive Parenteral Nutrition Support of Special Formula for Critical Patients

目的:观察特殊配方强化肠外营养支持对危重症患者的疗效。方法:选择2009-2011年在我院住院,急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)评分≥12,因肠内营养禁忌或者尝试48h出现不耐受,并需要>7d的完全肠外营养患者306例,随机分为特殊配方组(152例,采用谷氨酰胺、左卡尼汀、果糖二磷酸钠、混合糖等强化肠外营养治疗)与对照组(154例,进行常规肠外营养治疗)。2组相同疾病的其余治疗方法相同,2组胰岛素量以控制血糖于8.3mmol/L左右个体化给予。比较2组平均每天热量、脂肪乳、碳水化合物和氨基酸摄入量与平均每天胰岛素量、住院期间死亡率、治疗后APACHEⅡ评分、住院死亡患者的住院生存时间。结果:2组平均每天热量、脂肪乳和氨基酸量以及碳水化合物摄入差异无统计学意义(P>0.05),说明2组具可比性;特殊配方组胰岛素用量明显少于对照组(P<0.01);特殊配方组治疗后APACHEⅡ评分、住院期间死亡率、住院死亡患者的住院生存时间明显优于对照组(P<0.01或P<0.05)。结论:通过采用果糖二磷酸钠、左卡尼汀、谷氨酰胺、混合糖等强化肠外营养支持,可改善危重症患者代谢状况,从而改善患者临床预后,延长患者生存时间。

To observe therapeutic efficacy of intensive parenteral nutrition support of special formula in critical patients. METHODS ： 306 inpatients with APACHE Ⅱ score ≥ 12, who appeared intolerance because of enteral nutrition contraindication or attempted for 48 hours and needed more than 7 days of complete parenteral nutrition in our hospital during 2009-2011, were randomly divided into special formula group （152 cases, intensive parenteral nutrition support of glutamine, levocarnitine, sodium magnesium fructose diphosphate, mixture of sugar） and control group （154 cases, conventional parenteral nutrition support）. 2 groups of same disease were same in other treatment methods, and the dose of insulin in 2 groups were given individually in order to control blood sugar about 8.3 mmol/L. Average daily quantity of heats, amount of fat milk, carbohydrate and amino acid intake, average daily insulin quantity, mortality rate during hospitalization, post-treatment APACHE Ⅱ score and survival time of death inpatients in hospital were compared between 2 groups. RESULTS： There were no statistical significance between 2 groups in average daily quantity of heats, amount of fat milk, carbohydrate and amino acid iritake （P〉0.05）, which indicated 2 groups were comparable; the insulin amount, post-treatment APACHE Ⅱ score, mortality rate during hospitalization and survival time of death inpatients in special formula group were better than in control group obviously （P〈0.01 or P〈0.05）. CONCLUSION： Intensive parenteral nutrition support of glutamine, levocamitine, sodium magnesium fructose diphosphate, mixture of sugar may improve the metabolism condition of critical patients so as to improve the clinical prognosis of patients and lengthen the survival time.