谷氨酰胺对老年MODS患者中心静脉导管相关血行感染的影响

Effects of glutamine on catheter-related blood stream infections in elderly with multiple organ dysfunction syndrome

目的观察谷氨酰胺（Gln）对老年多器官功能障碍综合征（MODS）患者中心静脉导管相关感染的影响。方法人住南京市中医院重症监护病房（ICU）并使用中心静脉导管的老年MODS患者96例，随机分为Gin组（A组）和对照组（B组），Gin组在对照组基础上加用丙氨酰谷氨酰胺加强治疗，比较两组患者中心静脉导管相关血行感染（CRBSI）的发生情况。结果A组患者CRBSI发生率较B组明显降低，B组的导管保留天数明显长于B组；两组患者细菌学培养结果提示以肠道革兰阴性菌为主的培养阳性率A组较B组明显降低，而革兰阳性菌和真菌培养的阳性率两组无明显差异。结论对老年MODS患者加用Gln强化营养治疗，可以明显降低中心静脉CRBSI的发生率，尤其是革兰阴性菌的感染率，并延长导管的使用时间。

Objective To determine the clinical effects of glutamine （Gin） on central venous catheter-related blood stream infections （CRBSI） in the elderly patients with multiple organ dysfunction syndrome （MODS）. Methods A total of 96 elderly patients with MODS and central venous catheters hospitalized in our intensive care unit （ICU） from January 2012 to December 2013 were recruited in this study. They were prospectively divided into 2 groups at random, Gin group and control group. The control group received conventional treatments for MODS, while the Gin group received these treatments plus glutamine treatment. The incidence of CRBSI was compared between the 2 groups. Results Compared with the control group, the Gin group had significantly lower incidence of CRBSI, and longer duration of catheter retention. Bacterial culture results indicated that the positivity rate of Gram-negative bacteria was significantly lower in Gin group than in control group, but there was no significant difference in Gram-positive bacteria and fungi between the 2 groups. Conclusion Gln significantly reduces the incidence of CRBSI, especially for catheter retention. For the elderly MODS patients, fortified nutrition support with Gram-negative bacterial infection, and extends the duration of