谷氨酰胺颗粒复合肠内营养对严重多发伤患者免疫功能及预后的影响

目的评价谷氨酰胺颗粒复合肠内营养对严重多发伤患者免疫功能及预后的影响。方法选择2016年7月至2017年6月急诊ICU严重多发伤患者40例，随机分为谷氨酰胺组和对照组，各20例。两组患者采用等氮、等热量的肠内营养支持l周，谷氨酰胺组额外添加谷氨酰胺颗粒（30g／d）。入组当天及第7天记录急性生理学及慢性健康状况评分（APACHEⅡ），并抽血检测免疫球蛋白及补体（IgG、IgM、IgA、C3、C4）与淋巴细胞亚群（CD4、CD8、CD4／CD8、NK）。统计患者脓毒症发生率、ICU住院时间、28d生存与死亡情况。结果营养支持后第7天，谷氨酰胺组IgG、IgA、IgM、CD4、NK、CD4／CD8均明显高于对照组（P〈005）。但第74APACHEII评分、脓毒症发生率、ICU住院时间、28d病死率差异均无统计学意义。结论谷氨酰胺颗粒复合肠内营养能有效改善严重多发伤患者的免疫功能。

Objective To observe the effects of enteral nutrition supplemented with glutamine granules on immunologic function and prognosis in patients with severe multiple trauma. Methods A total of 40 patients with severe multiple trauma were included and randomly divided into 2 groups ： control group （ n=20 ） and glutamine treated group （Gln group, n=20 ） . All patients were given isonitrogenous and isocaloric intake with oral or tube feeding for 7 days. Glutamine granules （ 30g/d ） were administered in the Gln group. The immunoglobulin and alexin （ IgG, IgM, IgA, C3, C4 ） , and T-lymphocyte subsets （ CD4, CD8, CD4/CD8, NK） were detected on the first and seventh day of the nutrition support. The incidence of sepsis, APACHE ]I score, ICU hospitalization time, and 28-day mortality rate were recorded. Results After taking glutamine granules for 7 days, IgG, IgA, IgM, CD4, NK, CD4/CD8 in the Gln group were remarkably higher than these in the control group. However, there was no significant difference in the incidence of sepsis, APACHE U score, ICU hospitalization time, and 28-day mortality rate between 2 groups. Conclusion Glutamine granule-supplemented enteral nutrition improves immunological function in patients with severe multiple trauma.