丙氨酰谷氨酰胺注射液配合肠内、外营养对神经外科术后颅内感染患者营养状态及免疫功能的影响

Effect of alanyl glutamine added in parenteral nutrition combined with enteral nutrition on nutrition status and immune function of patients of postoperative Intracranial infection of neurosurgery

目的研究联合肠内、外营养支持加丙胺酰谷氨酰胺静脉注射对神经外科术后颅内感染患者营养及免疫能力调节作用。方法术后颅内感染患者60例，随机分为实验组和对照组，均于感染后给予7～14天联合肠内＋肠外营养支持治疗，实验组患者每天加用丙胺酰谷氨酰胺注射液0．4g／kg。检测患者确诊感染后2天、7天、14天的胃肠道功能、三头肌皮皱褶厚度（triceps skinfold thickness，TSF）及上臂肌围（arm muscle circumference，AMC），检测患者静脉血免疫球蛋白G（IgG）、C反应蛋白（CRP）、血清降钙素原（PCT）、T淋巴细胞亚群（CD4＋、CD8＋、CD4＋／CD8＋）、统计营养支持干预期间的医疗费用和总住院时间，并进行比较分析。结果实验组腹胀、腹泻、便秘的发生率低于对照组，差异有统计学意义（P〈0．05）。TSF及AMC在干预前后组间比较，差异无统计学意义（P〉0．05）。两组患者的治疗初始IgG比较，差异无统计学意义（P〉0．05）。在营养干预后第7天、14天，实验组的IgG及CD4＋、CD4＋／CD8＋明显高于对照组（P〈0．05）。营养干预后第7天、14天，实验组CRP的水平明显低于对照组（P〈0．05）。在营养干预后的第14天时，实验组PCT的水平明显低于对照组（P〈0．05）。实验组营养治疗期间的平均医疗费用较低（P〈0．05）。结论术后颅内感染患者在充分常规营养治疗基础上加用丙胺酰谷氨酰胺注射液更能有效改善机体营养和免疫状况，减少治疗费用。

Objective To explore effect of alanyl glutamine added in parenteral nutrition plus enteral nutrition on nutrition status and immune function with patients of the operation of Postoperative Intracranial infection of neurosurgery. Methods 60 patients were divided into treatment group and control group randomly ,30 cases in the control group and 30 cases in the experimental group. Patients in both groups were given neurosurgery routine treatments and parenteral nutrition plus enteral nutrition with the proper amount of nitrogen and calorie for 7 to 14 days immediately after infection. The treatment group added extra glutamine 0.4 g/kg. TSF and AMC of the patients were recorded at the 2nd, 7th and 14th day. Immunoglobulins Ig G, T lymphocyte subsets （ CD4＋ , CD8 ＋ , CD4＋/CD8 ＋ ）, CRP, PCT in venous blood were tested at the same time. Therapy expenses during the trial and hospitalization time were also compared. Results The incidence of abdominal distention, diarrhea and constipation for the test group were significantly lower than control group（P 〈 0.05）. There was no significant difference of the TSF and AMC between the two groups on 7th and 14th day after the intervention（P 〉0.05）. Ig G of the treatment group was higher than the control group on the 7th, 14th day （ P 〈 0.05 ）, CD4＋ , CD4＋/CD8 ＋ were the same（ P 〈 0.05 ）. The level of CRP of treatment group was lower than control group on the 7th and 14th day（ P 〈 0.05 ）. The level of PCT of treatment group was lower than control group on the 14th day （ P 〈 0.05 ）. The average therapy expense of the treatment group was significantly less during the trial （ P 〈 0.05 ）. There was no significant difference of hospitalization time between the two groups （P 〉 0. 05 ）. Conclusion Traditional nutritional therapy added with alanyl glutamine can significantly improve body nutrition and immunity of patients with postoperative neurosurgery intracranial infection, and also decrease the therapy expense.