谷氨酰胺联合膳食纤维强化肠内营养对重症医学科患者的支持效果

Clinical effects of glutamine and dietary fiber enhanced enteral nutrition in critically ill trauma patients

目的:探讨谷氨酰胺(glutamine,Gln)、膳食纤维(dietary fiber,DF)强化的肠内营养(enteral nutrition,EN)对创伤危重患者的支持效果.方法:按照随机数字表法将86例需行EN的危重患者均分为实验组和对照组,两组患者均给予常规EN治疗,实验组患者在此基础上添加Gln和可溶性膳食纤维(soluble dietary fiber,SDF),比较两组患者EN前后血红蛋白(heamoglobin,HGB)、血清总蛋白(total serum protein,TP)、白蛋白(albumin,ALB)、T淋巴细胞亚群(CD4+、CD8+及CD4+/CD8+)、免疫球蛋白(IgA、IgG、IgM)、空腹血糖值(fasting blood glucose,FBG)和C反应蛋白(C-reactive protein,CRP)水平变化情况以及胃肠道不良反应发生情况.结果:两组患者EN后HGB、TP、ALB、CD4+、CD4+/CD8+、IgA、IgG、IgM水平均显著升高(130.77 g/L±10.21 g/L vs 94.55 g/L±7.24 g/L,67.87 g/L±2.21 g/L vs 50.95 g/L±10.23 g/L,36.87 g/L±2.41 g/L vs 21.55 g/L±4.24 g/L,50.02%±8.62%vs 42.19%±9.52%,2.37±0.06 vs 1.61±0.08,3.32 g/L±0.67 g/L vs 2.20 g/L±0.69 g/L,15.11 g/L±3.85 g/L vs10.40 g/L±2.59 g/L,1.79 g/L±0.45 g/L vs 1.39g/L±0.49 g/L,110.39 g/L±9.88 g/L vs 97.72g/L±8.36 g/L,59.39 g/L±3.00 g/L vs 40.77g/L±3.06 g/L,30.79 g/L±2.33 g/L vs 20.59g/L±5.54 g/L,46.22%±6.58%vs 41.44%±7.87%,2.53±0.06 vs 1.67±0.07,2.45 g/L±0.51 g/L vs 2.19 g/L±0.65 g/L,12.24 g/L±3.82 g/L vs 10.48 g/L±3.03 g/L,1.69 g/L±0.53g/L vs 1.24 g/L±0.44 g/L(P<0.05 or P<0.01),CD8+、FBG、CRP水平均显著下降(19.94%±2.66%vs 25.20%±5.27%,8.11 mmol/L±2.06mmol/L vs 14.57 mmol/L±2.12 mmol/L,1.49mg/L±0.39 mg/L vs 6.53 mg/L L±1.33 mg/L,19.13 mmol/L±2.15 mmol/L vs 25.17 mmol/L±3.32 mmol/L,10.79 mmol/L±1.33 mmol/L vs 14.64 mmol/L±2.31 mmol/L,5.19 mg/L±2.11 mg/L vs 6.51 mg/L±1.44 mg/L),与EN前比较,差异具有统计学意义(P<0.05或P<0.01);实验组患者EN后HGB、TP、ALB、CD4+、IgA、IgG水平均显著高于对照组(130.77 g/L±10.21 g/L vs 110.39 g/L±9.88 g/L,67.87 g/L±2.21 g/L vs 59.39 g/L±3.00 g/L,36.87 g/L±2.41 g/L vs 30.79 g/L±2.33 g/L,50.02%±8.62%vs 46.22%±6.58%,3.32 g/L±0.67 g/L vs 2.45 g/L±0.51 g/L,15.11 g/L±3.85 g/L vs12.24 g/L±3.82 g/L(P<0.05或P<0.01),FBG、C R P水平和便秘发生率均显著低于对照组(8.11 mmol/L±2.06 mmol/L vs 10.79 mmol/L±1.33 mmol/L,1.49 mg/L±0.39 mg/L vs 5.19mg/L±2.11 mg/L,13.95%vs 30.23%)(P<0.05或P<0.01),差异具有统计学意义.结论:Gln、DF强化的肠内营养能够有效改善患者营养状态、增强免疫力、减轻应激反应、改善胃肠功能、防止并发症发生,疗效显著,应用和推广价值较高.

AIM： To explore the clinical effects of glutamine and dietary fiber enhanced enteral nutrition（EN） in critically ill trauma patients. METHODS： Eighty-six patients with critically ill trauma were randomly divided into either an experiment group or a control group. Patients in both groups were treated by conventional EN. On the basis of conventional EN, the experiment group was additionally given glutamine（Gln） and soluble dietary fiber. The levels of heamoglobin（HGB）, total serum protein（TP）, albumin（ALB）, CD4＋, CD8＋, CD4＋/CD8＋, IgA, IgG, IgM, fasting blood glucose（FBG）, C-reactive protein（CRP） and the gastrointestinal adverse effects were compared between the two groups and between before and after treatment.RESULTS： In both groups, the levels of HGB, TP, ALB, CD4＋, CD4＋/CD8＋, IgA, IgG, and IgM were significantly higher（130.77 g/L ± 10.21 g/L vs 94.55 g/L ± 7.24 g/L, 67.87 g/L ± 2.21 g/L vs 50.95 g/L ± 10.23 g/L, 36.87 g/L ± 2.41 g/L vs 21.55 g/L ± 4.24 g/L, 50.02% ± 8.62% vs 42.19%± 9.52%, 2.37 ± 0.06 vs 1.61 ± 0.08, 3.32 g/L ± 0.67 g/L vs 2.20 g/L ± 0.69 g/L, 15.11 g/L ± 3.85 g/L vs 10.40 g/L ± 2.59 g/L, 1.79 g/L ± 0.45 g/L vs 1.39 g/L ± 0.49 g/L, 110.39 g/L ± 9.88 g/L vs 97.72 g/L ± 8.36 g/L, 59.39 g/L ± 3.00 g/L vs 40.77 g/L ± 3.06 g/L, 30.79 g/L ± 2.33 g/L vs 20.59 g/L ± 5.54 g/L, 46.22% ± 6.58% vs 41.44% ± 7.87%, 2.53 ± 0.06 vs 1.67 ± 0.07, 2.45 g/L ± 0.51 g/L vs 2.19 g/L ± 0.65 g/L, 12.24 g/L ± 3.82 g/L vs 10.48 g/L ± 3.03 g/L, 1.69 g/L ± 0.53 g/L vs 1.24 g/L ± 0.44 g/L; P〈0.05 or P〈0.01）, and the levels of CD8＋, FBG, and CRP were significantly lower（19.94% ± 2.66% vs 25.20% ± 5.27%, 8.11 mmol/L ± 2.06 mmol/L vs 14.57 mmol/L ± 2.12 mmol/L, 1.49 mg/L ± 0.39 mg/L vs 6.53 mg/L L ± 1.33 mg/L, 19.13% ± 2.15% vs 25.17% ± 3.32%, 10.79 mmol/L ± 1.33 mmol/L vs 14.64 mmol/L ± 2.31 mmol/L, 5.19 mg/L ± 2.11 mg/L vs 6.51 mg/L ± 1.44 mg/L; P〈0.05 or P〈0.01） after EN than before EN. After EN, the levels of HGB, TP, ALB, CD4＋, IgA, and IgG in the experiment group were significantly higher than those in the control group（130.77 g/L ± 10.21 g/L vs 110.39 g/L ± 9.88 g/L, 67.87 g/L ± 2.21 g/L vs 59.39 g/L ± 3.00 g/L, 36.87 g/L ± 2.41 g/L vs 30.79 g/L ± 2.33 g/L, 50.02% ± 8.62% vs 46.22% ± 6.58%, 3.32 g/L ± 0.67 g/L vs 2.45 g/L ± 0.51 g/L, 15.11 g/L ± 3.85 g/L vs 12.24 g/L ± 3.82 g/L; P〈0.05 or P〈0.01）, while the levels of FBG, CRP and the rate of constipation were significantly lower in the experiment group than in the control group（8.11 mmol/L ± 2.06 mmol/L vs 10.79 mmol/L ± 1.33 mmol/L, 1.49 mg/L ± 0.39 mg/L vs 5.19 mg/L ± 2.11 mg/L, 13.95% vs 30.23%; P〈0.05 or P〈0.01）.CONCLUSION： Glutamine and dietary fiber enhanced enteral nutrition can improve the nutritional status and immune function, promote the gastrointestinal vermicular motion, and thereby improve the gastrointestinal function.