谷氨酰胺联合短肽型肠内营养干预对重症颅脑损伤患者康复效果及免疫功能的影响

Rehabilitation effect and immune functions of glutamine combined with short peptide enteral nutrition intervention on patients with severe craniocerebral injury

目的探究谷氨酰胺联合短肽型肠内营养干预应用于重症颅脑损伤患者康复中的效果。方法选取2019年3月至2022年3月北京航天总医院营养科接诊的84例重度颅脑损伤术后昏迷患者,采用随机数字表法分为研究组(42例)和对照组(42例),对照组予以短肽型肠内营养干预治疗,研究组采用短肽型肠内营养干预联合谷氨酰胺治疗。治疗7 d后,评估研究组和对照组患者的康复效果、血清营养指标、免疫功能指标、炎症因子、肠黏膜屏障功能指标及药物不良反应。结果研究组治疗后的格拉斯哥昏迷评分(glasgow coma scale,GCS)、苏醒率、总蛋白、白蛋白、前白蛋白、免疫球蛋白(immunoglobulin,lg)A、lgM、CD4^(+)、CD4^(+)/CD8^(+)分别为(12.51±2.06)分、100.00%(42/42)、(71.49±5.44)g/L、(38.69±4.05)g/L、(304.52±39.61)g/L、(3.31±0.47)g/L、(1.94±0.58)g/L、(35.65±3.18)%、(1.23±0.29),均高于对照组的(10.77±1.89)分、90.47%(38/42)、(66.28±5.73)g/L、(34.56±3.72)g/L、(274.53±40.15)g/L、(2.79±0.39)g/L、(1.61±0.49)g/L、(32.53±3.24)%、(1.09±0.32),组间差异有统计学意义(t/χ^(2)值分别为4.03、4.20、4.27、4.87、3.45、5.52、2.82、4.45、2.10,P值均<0.05)。研究组治疗后的C反应蛋白(c-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、血浆二胺氧化酶(diamine oxidase,DAO)、尿乳果糖/甘露醇(lactulose/mannitol ratio,L/M)分别为(34.29±4.71)mg/L、(35.26±5.79)ng/L、(0.89±0.14)μmol/L、(0.12±0.04),均低于对照组的(45.17±3.95)mg/L、(40.59±6.34)ng/L、(0.96±0.17)μmol/L、(0.19±0.05),组间差异有统计学意义(t值分别为11.47、4.02、2.06、7.09,P值均<0.05)。两组患者均未出现严重不良反应。结论谷氨酰胺联合短肽型肠内营养干预应用于重症颅脑损伤患者康复治疗中,有助于改善患者昏迷状态、改善肠道营养、抑制炎症反应、促进患者的免疫功能恢复。

Objective To explore the effect of glutamine combined with short peptide enteral nutrition intervention in the rehabilitation of patients with severe craniocerebral injury.Methods Between March 2019 and March 2022,84 patients with coma after severe craniocerebral injury received by the Nutrition Department of Beijing Aerospace general hospital were randomly divided into the study group(42 cases)and the control group(42 cases).The control group was treated with short peptide enteral nutrition intervention,and the study group was treated with short peptide enteral nutrition intervention combined with glutamine.After 7 days of treatment,the rehabilitation effect,serum nutritional indexes,immune function indexes,inflammatory factors,intestinal mucosal barrier function indexes and adverse drug reactions were evaluated.Results The Glasgow coma scale(GCS),recovery rate,total protein,albumin,prealbumin,immunoglobulin(lg)A,lgM,CD4^(+),and CD4^(+)/CD8^(+)in the study group after treatment were(12.51±2.06)points,100.00%(42/42),(71.49±5.44)g/L,(38.69±4.05)g/L,(304.52±39.61)g/L,(3.31±0.47)g/L,(1.94±0.58)g/L,and(35.65±3.18)%,respectively(1.23±0.29),all higher than the control group's(10.77±1.89)points,90.47%(38/42),(66.28±5.73)g/L,(34.56±3.72)g/L,(274.53±40.15)g/L,(2.79±0.39)g/L,(1.61±0.49)g/L,(32.53±3.24)%,and(1.09±0.32),with statistically significant differences between the groups t values were 4.03,4.20,4.27,4.87,3.45,5.52,2.82,4.45,and 2.10,respectively,all P values<0.05).After treatment,the levels of C-reactive protein(CRP),interleukin-6(IL-6),plasma diamine oxidase(DAO),and urinary lactulose/mannitol ratio(L/M)in the study group were(34.29±4.71)mg/L,(35.26±5.79)ng/L,and(0.89±0.14)μmol/L,(0.12±0.04),respectively,all lower than the control group's(45.17±3.95)mg/L,(40.59±6.34)ng/L,(0.96±0.17)μmol/L,(0.19±0.05),there was a statistically significant difference between the groups(t values were 11.47,4.02,2.06,and 7.09,respectively,all P values<0.05).No serious adverse reactions were observed in both groups.Conclusion The application of glutamine combined with short-peptide enteral nutrition intervention in the rehabilitation treatment of severe traumatic brain injury patients can help improve patients'coma status,enhance intestinal nutrition,inhibit inflammatory reactions,and promote immune function recovery.