基于L-丙氨酰谷氨酰胺的肠外营养在ICU重症颅脑损伤的应用

Application of L-alanylglutamine-based Parenteral Nutrition in ICU with Severe Head Injury

目的:探讨基于L-丙氨酰谷氨酰胺的肠外营养在重症监护病房(Intensive Care Unit,ICU)重症颅脑损伤的应用价值.方法:2018年6月到2020年6月选择在本院ICU诊治的重症颅脑损伤患者540例,根据随机数字表法把患者分为研究组与对照组各270例.对照组给予标准肠外营养支持方法,研究组在对照组治疗的基础上给予L-丙氨酰谷氨酰胺辅助治疗,两组都治疗观察14d.结果:研究组治疗第7d与14d的营养不足发生率分别为4.8%和6.7%,显著低于对照组的13.0%和17.0%(P<0.05).两组治疗后的血清总蛋白与白蛋白含量高于治疗前,研究组高于对照组,对比差异都有统计学意义(P<0.05).研究组治疗期间的肺部感染、尿路感染、消化道反应、压疮等并发症发生率为4.8%,显著低于对照组的15.6%(P<0.05).两组治疗后的血清降钙素原(Procalcitonin,PCT)值低于治疗前,研究组低于对照组,对比差异都有统计学意义(P<0.05).结论:基于L-丙氨酰谷氨酰胺的肠外营养在ICU重症颅脑损伤的应用能降低患者营养不足与并发症发生率,促进恢复机体的营养状况,抑制PCT的释放.

Objective: To explore the application values of L-alanylglutamine-based parenteral nutrition in the Intensive Care Unit(ICU) of severe head injury. Methods: A total of 540 patients with severe head injury, who were diagnosed and treated in the ICU of First Affiliated Hospital of Xinjiang Medical University from June 2018 to June 2020, were selected and were randomly divided into study group(n=270) and control group(n=270). The control group was given standard parenteral nutrition support, and the study group was given L-alanylglutamine adjuvant therapy based on the treatment of the control group. Both groups were treated and observed for 14 days.Results: The incidence(4.8 % and 6.7 %) of undernutrition on the 7 th and 14 th day of treatment in the study group was significantly lower than that(13.0 % and 17.0 %) in the control group(P<0.05). The serum total protein and albumin content of the two groups after treatment were higher than that before treatment, and the study group was higher than that of the control group, and the differences were statistically significant(P<0.05). The incidence of complications such as lung infection, urinary tract infection, digestive tract reaction, pressure ulcers, etc. during treatment in the study group was 4.8 %, which were significantly lower than that(15.6 %) in the control group(P<0.05). The serum procalcitonin(PCT) value of the two groups after treatment was lower than that before treatment, and the study group was lower than that of the control group, the difference was statistically significant(P<0.05). Conclusion: The application of parenteral nutrition based on L-alanylglutamine in ICU with severe head injury can reduce the incidence of undernutrition and complications, promote the restoration of the body’s nutritional status, and inhibit the release of PCT.