谷氨酰胺强化早期肠内营养治疗重症急性胰腺炎的临床观察

Effect of Glutamine-Fortified Early Intensive Enteral Nutrition in Patients with Severe Acute Pancreatitis

目的研究谷氨酰胺联合早期肠内营养对重症急性胰腺炎的治疗作用。方法将60例重症急性胰腺炎患者采用随机数字表法分为3组:肠外营养组(PN组)、肠内营养组(EN组)和肠内营养+谷氨酰胺组(EN+Gln组)。3组患者均于治疗前及治疗后5和10 d分别取血测定血清中的清蛋白(ALB)、前清蛋白(PAB)、转铁蛋白(TF)、CD3、CD4、CD8、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、Gln、内毒素(ET)的水平,并统计3组患者感染率、死亡率、转手术率、多器官功能障碍综合征(MODS)发生率、平均住院时间、平均住院费用。结果①营养治疗后,3组患者CD3、CD4、CD8、CD4/CD8逐渐升高;治疗后10 d,EN组高于PN组,EN+Gln组高于EN组(P<0.05)。②营养治疗后,3组患者CRP、IL-6、TNF-α逐渐降低;治疗后10 d,EN组低于PN组,EN+Gln组低于EN组,差异有统计学意义(P<0.05)。③营养治疗后10 d,3组患者血清Gln水平均升高,EN+Gln组明显高于PN组和EN组(P<0.05)。④PN组患者ET逐渐升高,而EN组和EN+Gln组患者ET逐渐下降,与治疗前比较均差异有统计学意义(P<0.05);EN+Gln组较EN组下降更明显(P<0.05)。⑤在感染率、MODS发生率、平均住院时间、平均住院费用方面,EN组低于PN组,EN+Gln组低于EN组(P<0.05)。结论 Gln联合早期肠内营养可以改善重症急性胰腺炎患者营养代谢和免疫功能,促进消化道功能的恢复,阻止细菌和内毒素的移位,减少炎性反应,其作用要优于单纯肠内营养。

Objective To evaluate the effect of early enteral nutrition（EN） supplemented with glutamine （Gln） in the patients with severe acute pancreatitis （SAP）. Methods Sixty SAP patients were randomly divided into three groups： parenteral nutrition group（PN, n=20）, enteral nutrition group（EN, n=20） and EN＋Gln group（n=20）. Blood samples were collected for analysis of albumin （ ALB ）, pre-albumin （ PAB ）, transferrin （ TF ）, CD3, CD4, CD8, C-reactive protein （ CRP ）, interleukin-6（ IL-6 ）, tumor necrosis factor-α （ TNF-α ）, glutamine, endotoxin （ET） before treatment, 5 and 10 days after nutrition treatment. The infection rate, death rate, operation switching rate, MODS rate, duration and cost of hospitalization were measured as well. Results （1） The CD3 , CD4, CDs and CDn/CDs levels were increased after treatment, and those in the EN＋ Gin group were significantly higher than those in other groups after 10 days of treatment （ all P〈0.05）. （~）The CRP, IL-6 and TNF-α secretion decreased after treatment, specifically for those in the EN＋Gln group which were lower than the EN group 10 days after treatment（all P〈0.05）. （2）Glutamine level increased 10 days after treatment, Post-treatment glutamine level in the EN＋Gln group was significantly higher than that in all other groups （ P〈0.05 ）. （3）Endotoxin levels elevated gradually in PN group while ET levels in both EN and EN＋Gln groups significantly decreased after treatment （P〈0.05）. Post-treatment LPS level was significantly lower in the EN＋Gln group compared with that in the EN group （P〈0.05）. （4） The inf6cti＇on rate, MODS rate, duration and cost of hospitalization were significantly lower in the EN＋Gln group compared to other groups （all P〈0.05 ）. Conclusion For patients with severe acute pancreatitis, EN combined with Gin is superior to EN alone in improving body nutritional metabolism and immunological function. The Gin-fortified EN promots the recovery of digestive function, prevents translocation of bacterial and endotoxin, and reduces inflammatory responses.