谷氨酰胺肠内营养对ICU急性胰腺炎患者的预后影响

Prognostic impact of glutamine enteral nutrition for acute pancreatitis in ICU

目的探讨谷氨酰胺对肠内营养ICU急性胰腺炎患者的预后影响。方法将近5年本院ICU收治的68例重症急性胰腺炎患者纳入研究,随机分成:观察组和常规组,各34例。观察组接受谷氨酰胺肠内营养,常规组接受常规肠内营养,比较两组肝肾功能、免疫功能、炎症因子水平、APACHEⅡ评分与CT评分、感染与并发症发生、ICU入住天数、住院周期与医疗费用。结果治疗14 d后,观察组的Alb、PA、TRF指标水平均明显高于常规组(P<0.05);观察组的ALT、AST、hs-CRP、TNF-α、IL-1β、IL-6与IL-8指标水平均明显低于常规组(P<0.05);观察组的APACHEⅡ评分及CT评分明显低于常规组(P<0.05);观察组的感染率5.88%,并发症发生率17.65%和死亡率2.94%明显低于常规组的26.47%、41.18%、17.65%(P<0.05);观察组的ICU入住天数、住院周期及医疗费用均明显少于常规组(P<0.05)。结论谷氨酰胺肠内营养可纠正机体营养失衡和改善机体免疫功能,临床用于重症急性胰腺炎能缩短治疗时间、节省治疗费用,借鉴意义重大。

Objective To investigate the prognostic impact of glutamine enteral nutrition for acute pancreatitis in ICU. Methods 68 cases of severe acute pancreatitis patients admitted to our hospital in the period of nearly 5 years were randomly divided into two groups： the observation group（glutamine enteral nutrition） and regular group（conventional enteral nutrition）, each group of 34 cases. The liver and kidney function, immune function, inflammatory factor level, APACHEⅡ score and CT score, the incidence rate of infection and complication, ICU length of stay, hospitalization period and medical cost in the two groups were observed and compared. Results After 14 d of treatment, the levels of Alb, PA and TRF in the observation group was slightly higher than regular group（P〈0.05）; the levels of ALT, AST, hs-CRP, TNF-α, IL-1β, IL-6 and IL-8 in the observation group was significantly lower than regular group（P〈0.05）; the APACHEⅡscore and CT score in the observation group were significantly lower than regular group（P〈0.05）; the incidence rate of infection, complication and mortality in the observation group were slightly lower than the regular group（5.88% vs 26.47%, 17.65% vs 41.18%, 2.94% vs 17.65%, P〈0.05）, ICU length of stay, hospitalization period and medical cost in the observation group were significantly less than regular group（P〈0.05）. Conclusion Glutamine enteral nutrition in the treatment of acute pancreatitis can correct the nutritional imbalance and improve the immune function, shorten the treatment time, save medical costs, drawing on the significance.