肠外营养添加丙胺酰谷氨酰胺和大剂量维生素C对急性重症创伤病人的治疗效果

PARENTERAL NUTRITION PLUS ALANYL GLUTAMINE AND LARGE DOSES OF VITAMIN C IN THE TREATMENT OF PATIENTS WITH ACUTE SEVERE TRAUMA

目的探讨肠外营养添加丙胺酰谷氨酰胺和大剂量维生素C治疗急性重症创伤病人的应用价值。方法应用前瞻、随机对照的方法,将60例急性重症创伤病人分为对照组(传统肠外营养治疗)和治疗组(传统肠外营养治疗添加丙氨酰谷氨酰胺和大剂量维生素C),观察两组病人临床疗效及相关指标变化。结果治疗后治疗组病人的急性生理和既往健康评价系统评分(APACHEⅡ评分)显著低于对照组(t=-2.934,P<0.01);多脏器功能障碍综合征(MODS)、高糖血症、感染发生率及营养、氧化应激、免疫指标与对照组比较差异有显著性(χ2=6.172～7.190,t=6.687～14.515,P<0.05);6个月时的生存率比对照组提高23.3%(χ2=8.264,P<0.05)。结论对于急性重症创伤病人,早期应用丙氨酰谷氨酰胺联合大剂量维生素C治疗,MODS、感染、高糖血症等并发症的发生率明显下降,可明显改善重症病人的预后,提高长期生存率。

Objective To assess the value of parenteral nutrition plus alanyl glutamine and large doses of vitamin C in the treatment of acute severe trauma. Methods By using a prospective and randomized controlled method, 60 patients with acute severe trauma were divided into control group and treatment group. The patients in the control group were treated with traditional parenteral nutrition; those in the treatment group were treated with traditional parenteral nutrition plus alanyl-glutamine and large- dose vitamin C. The clinical efficacy and related indexes in two groups were observed. Results After therapy, the score of physi- ology and chronic health evaluation system （APACHE II score） was significantly lower in patients in the treatment group than the control, the difference was statistically significant （t =- 2.934 ,P 〈0.01） ; the differences between the two groups were significant in terms of hyperglycemia, MODS, infection rate and nutrition, oxidative stress and immune （x^2 = 6. 172- 7. 190, t = 6. 687- 14.515,P〈0.05）. The six-month survival rate in treatment group increased by 23.3% versus the control （x^2 =8.264,P〈0.05）. Conclusion For patients with acute severe trauma, early use of alanyl glutamine combined with large-dose vitamin C therapy may reduce complications such as MODS, infection, and hyperglycemia, and improve their prognosis and raise their long-term survival.