重症监护患者肠道黏膜屏障及免疫功能采用不同剂量谷氨酰胺肠内营养液的护理及效果观察

Effect of enteral nutrition solution with different dosage of glutamine on the intestinal mucosal barriers and immune functions of intensive care patients

目的探讨谷氨酰胺加入到肠内营养液中对重症监护患者肠道黏膜屏障及免疫功能的临床效果。方法选取某院重症监护患者150例作为观察对象,将其随机分为3组。低剂量组给予添加低剂量谷氨酰胺的常规肠内营养液,谷氨酰胺的剂量为0.3g/(kg·d);高剂量组给予添加高剂量谷氨酰胺的强化肠内营养液,高剂量组谷氨酰胺的剂量为0.6g/(kg·d),并给予相应的营养液输注护理;对照组不给予谷氨酰胺的强化肠外营养液。给予营养支持干预两周后,测定实验组和对照组的二胺氧化酶、谷氨酰胺水平以及免疫蛋白与T淋巴细胞亚群免疫指标的变化情况。结果肠内营养液中加入谷氨酰胺的患者的免疫蛋白(Ig A、Ig G、Ig M)与T淋巴细胞亚群(CD3+、CD4+/CD8+)免疫指标均优于对照组,高剂量组优于低剂量组,两两比较差异具有统计学意义(P<0.05)。结论对重症监护患者采用肠内营养液中加谷氨酰胺并采取相应护理措施,能有效改善其肠道黏膜屏障及免疫功能,且添加高剂量的谷氨酰胺临床效果更为显著,值得推广应用。

ObjectiveTo explore the clinical effect of enteral nutrition solution with different dosage of glutamine（Gln） on the intestinal mucosal barriers and immune functions of intensive care patients.Methods 150 intensive care patients in a certain hospital were randomly divided into three groups, the low dose group received the therapy of routine enteral nutrition solution with low dosage of Gln, and the dosage of Gln was 0.3g/（kg·d）, the high dose group received the therapy of strengthened enteral nutrition solution with high dosage of Gln and corresponding nutrient fluid infusion nursing care, the dosage of Gln was 0.6g/（kg·d）[1], and the control group was treated with strengthened parenteral nutrition solution without Gln. Two weeks after nutritional supporting intervention, the variations of diamine oxidase, Gln levels, immune proteins, and T lymphocyte subsets immune indexes of the three groups were tested and compared.Results The immune proteins（IGA, IgG, IgM） and T lymphocyte subsets（CD3＋, CD4＋/CD8＋） immune indexes of patients received the therapy of enteral nutrition solution with Gln were all better than those of the control group, the high dose group’s indexes were better than those of the low dose group, when pairwise compared,P〈0.05, the differences were statistically significant.Conclusion The therapy of enteral nutrition with Gln and corresponding nursing measures can effectively improve the intestinal mucosal barriers and immune functions of intensive care patients, and high dosage of Gln is more effective, which is worthy of clinical promotion.