谷氨酰胺膳食纤维和低聚果糖在老年机械通气患者肠内营养中的应用

Application of glutamine combined with dietary fibre support of elderly patients with mechanical ventilation and fructo-oligosaccharide in enteral nutrition

目的观察在肠内营养中添加谷氨酰胺（glutamine，G）、膳食纤维（dietary fibre，F）和低聚果糖（fructo-oligosaccharide，O），对老年机械通气患者营养状态、胃肠道功能改善及临床结局的影响。方法将采用机械通气老年患者90例完全随机分成3组，单纯肠内营养对照组（对照组），含谷氨酰胺的肠内营养组（谷氨酰胺组），含GFO的肠内营养组（GFO组），于营养支持的第1、7、14天清晨采集空腹静脉血，测定血红蛋白、血清白蛋白、转铁蛋白、前白蛋白等营养指标，同时观察患者腹胀、腹泻、胃潴留等胃肠道功能情况及记录每组患者的机械通气时间、重症监护病房（ICU）住院时间及肠内营养管拔管时间，并进行比较。结果营养支持后第7天转铁蛋白、前白蛋白明显改善（P=0．023，P=0．047），第14天血红蛋白明显改善（P=0．003）。谷氨酰胺组、GFO组成功实施肠内营养和达到肠内营养目标者分别是4例和25例、3例和27例，较对照组多（12例和13例，P=0．008，P=0．000），胃肠道的并发症发生率谷氨酰胺组、GFO组较对照组少。谷氨酰胺组、OFO组机械通气时间、ICU住院时间及拔管时间均比对照组短。结论含谷氨酰胺和GFO的肠内营养，均能早期改善机械通气患者的营养状态，并减少胃肠功能并发症。通过肠道给予GFO，更有利于成功实施肠内营养，改善患者的临床结局。

Objective To investigate the effects of enteral nutrition support with glutamine combined with dietary fibre and frueto oligosaceharide （GFO） on nutritional status, gastrointestinal function and outcome in elderly patients with mechanical ventilation. Methods Totally 90 patients were randomly divided into three group： the control group without additives （group A）, enteral nutrition group with glutamine （group B） or with GFO （group C）. Fasting blood samples were collected on day 1, 7 and 14 after the initiation of study, and then the indicators including hemoglobin, albumin, transferrin and prealbumin were determined. In addition, the gastrointestinal complications including bloating, diarrhea, and gastric retention were observed, and the mechanical ventilation time, length of intensive care unil （ICU） stay and extubation time were recorded. Results The serum transferrin and prealbumin levels were significantly improved on the 7th day （ P=0. 023 and 0. 047）, and the hemoglobin was significantly improved on the 14th day （P=0. 003）. 4 cases in group B and 3 cases in group C underwent successful implementation of enteral nutrition, and 25 cases in group B and 27 cases in group C achieved the target volume of enteral nutrition, which were more than those in group A （P=0. 008 and 0. 000 respectively）. The incidence of gastrointestinal complication was less in groups B and C than in group A. The mechanical ventilation time, length of ICU stay and extubation time were shorter in groups B and C than in group A. Conclusions Enteral nutrition with glutamine and GFO can improve nutritional status and reduce gastrointestinal complications in elderly patients with mechanical ventilation. Enteral nutrition with GFO has an advantage to the enteral nutrition and the outcome.