谷氨酰胺肠内营养+低分子肝素对重症肺炎患者全身炎症反应程度的影响

Effect of glutamine enteral nutrition+low molecular weight heparin on systemic inflammatory response in patients with severe pneumonia

目的:探讨谷氨酰胺肠内营养+低分子肝素对重症肺炎患者全身炎症反应程度的影响。方法:2017年1月～10月间在本院进行住院治疗的重症肺炎患者52例,经随机数表法将其分为谷氨酰胺组及对照组各26例。对照组接受常规肠内营养+低分子肝素治疗,谷氨酰胺组在对照组基础上加入谷氨酰胺营养液治疗,均持续7d。对比两组治疗前后血清炎症因子、氧化应激指标、心肌损伤指标含量的差异。结果:治疗前,两组血清中炎症因子、氧化应激指标、心肌损伤指标含量的差异不显著(P>0.05)。治疗7d后,谷氨酰胺组血清中炎症因子IL-10、IL-18的含量高于对照组,IL-17、sTREM-1、PCT的含量低于对照组;氧化应激指标MDA、LHP的含量低于对照组,GSH-Px、CAT的含量高于对照组;心肌损伤指标α-HBDH、cTnⅠ、NT-ProBNP、LDH的含量低于对照组(P<0.05)。结论:重症肺炎患者接受谷氨酰胺肠内营养+低分子肝素治疗,可有效缓解机体全身炎症及氧化应激反应,减轻心肌损伤。

Objective：To investigate the effect of glutamine enteral nutrition ＋ low molecular weight heparin on systemic inflammatory response in patients with severe pneumonia.Methods：A total of 52 patients with severe pneumonia who were hospitalized in this hospital between January 2017 and October 2017 were divided into glutamine group（n=26）and control group（n=26）by random number table method.Control group received conventional enteral nutrition ＋ low molecular weight heparin treatment,glutamine group were treated with glutamine nutrient solution on the basis of the therapy for control group,and both therapies lasted for 7 d.The differences in serum levels of inflammatory factors,oxidative stress indexes and myocardial injury indexes were compared between the two groups before and after treatment.Results：Before treatment,serum levels of inflammatory factors,oxidative stress indexes and myocardial injury indexes were not significantly different between the two groups（P〈0.05）.After 7 dof treatment,serum inflammatory factors IL-10 and IL-18 levels of glutamine group were higher than those of control group whereas IL-17,sTREM-1 and PCT levels were lower than those of control group;serum oxidative stress indexes MDA and LHP levels were lower than those of control group whereas GSH-Px and CAT levels were higher than those of control group;serum myocardial injury indexesα-HBDH,cTnⅠ,NT-ProBNP and LDH levels were lower than those of control group（P〈0.05）.Conclusion：Glutamine enteral nutrition ＋low molecular weight heparin can effectively relieve systemic inflammatory response and oxidative stress response,and reduce the myocardial injury in patients with severe pneumonia.