急性期强化谷氨酰胺的低蛋白低热卡营养支持对营养高风险重症患者的影响研究

Effects of low-protein and low-calorie nutritional support with glutamine supplementation in acute phase on critically ill patients with high nutritional risk

目的 探讨急性期给予强化谷氨酰胺的低蛋白低热卡的营养治疗对营养高风险的重症患者的影响。方法 选择2016年8月至2018年5月南昌市第一医院收治的营养高风险患者(NUTRIC评分≥5)80例,随机分为干预组(40例)及对照组(40例)。按照NUTRIC评分是否>7分划分亚组,5、6、7分为A组,8、9分为B组,即干预A组(30例)、干预B组(10例)、对照A组(29例)、对照B组(11例)共4个亚组。干预组摄入热卡量为目标热卡的20%~40%,蛋白质量为0.5~0.7 g/(kg·d)(含丙氨酰-谷氨酰胺),丙氨酰-谷氨酰胺计算量:0.3 g/(kg·d),丙氨酰-谷氨酰胺使用7 d。对照组摄入热卡量为目标热卡的70%~100%,蛋白质量为1.2~1.5 g/(kg·d)。主要终点是第28天生存期。次要终点为住院时间、机械通气时间及院内感染等。结果 生存曲线分析发现干预组与对照组患者第28天生存期没有显著差异(P>0.05),干预组患者较对照组患者不良事件、院内感染、ICU住院时间及机械通气时间明显减少(P<0.05)。亚组分析显示,在B组中,干预组中位生存期明显较对照组延长(P<0.05)。结论 与充足喂养相比,营养高风险的危重患者在急性期强化谷氨酰胺的低蛋白低热卡喂养与减少院内感染、减少呼吸机的使用有关,但未提高患者的第28天生存期。

Objective To inverstigate the effects of low-protein and low-calorie nutritional support with glutamine supplementation in acute phase on critically ill patients with high nutritional risk. Methods Totally 80 patients with high nutritional risk(NUTRIC score≥5)in the ICU or emergency intensive care unit of Nanchang First Hospital from August2016 to May 2018 were selected and randomly divided into an intervention group and a control group,with 40 cases in each group. Subgroups were divided according to whether the NUTRIC score was more than 7 points, the score of 5, 6, and 7 in group A, and 8 and 9 in group B, namely the intervention group A(30 cases), the intervention group B(10 cases), the control group A(29 cases) and the control group B(11 cases), a total of 4 subgroups. In the intervention group,intake of calories was 20%-40% of target calories,protein amount was 0.5-0.7 g/(kg · d)(including the amount of alanylglutamine),alanyl-glutamine calculated amount was 0.3 g/(kg·d),and alanyl-glutamine was used for 7 days. In the control group,the calorie intake was 70%-100% of the target calorie,and the protein content was 1.2-1.5 g/(kg·d). The primary endpoint was 28-day survival. The secondary endpoints were hospital stay,mechanical ventilation time and nosocomial infection rate. Results Survival curve analysis revealed no significant difference in 28-day survival and between the two groups(P>0.05);the patients in the intervention group had significantly lower rate of adverse events and nosocomial infection,and shorter length of stay in ICU and time of mechanical ventilation than the control group(P<0.05).Subgroup analysis showed that in group B,the median survival of intervention group was significantly longer than that of control group(P<0.05). Conclusions Compared to full feeding,glutamine-enhanced low-protein and low-calorie feeding of critically ill patients with high nutritional risk during the acute phase can reduce the nosocomial infections and the use of ventilators,but it does not improve the 28-day survivalof patients.