早期肠内营养添加谷氨酰胺对老年重型颅脑损伤患者免疫功能和营养代谢的影响  

Effects of Early Enteral Nutrition and Glutamine-supplemented EEN on the Immune Function and Nutritional Metabolism in Old Patients With Severe Brain Injury

作　　者：曾钧发[1] 肖宏[1] 桂培根[1] 

机构地区：[1]南华大学附属第二医院重症医学科,湖南衡阳421001

出　　处：《中南医学科学杂志》2012年第5期490-492,共3页Medical Science Journal of Central South China

摘　　要：目的观察早期肠内营养中添加谷氨酰胺对老年重型颅脑损伤患者免疫功能和营养代谢的影响。方法将60例病人回顾性分为两组,即常规肠内营养组和谷氨酰胺强化的肠内营养组(谷氨酰胺营养组)。对两组进行急性生理改变及慢性疾病基础综合评分(APACHE-Ⅱ评分),并检测患者外伤后第1天、第7天、第14天的IgA、IgG、IgM和T细胞亚群,同时监测白蛋白(ALB)、转铁蛋白(TF)及氮平衡(NB)等营养代谢指标。结果两组治疗第7天、第14天IgA,IgG,CD4^+,CD8^+及CD4^+/CD8^+比值均较治疗第1天逐渐升高(均P<0.01),且谷氨酰胺营养组的上述各指标在外伤后第7、第14天均显著高于常规肠内营养组(均P<0.01)。两组治疗第7天、第14天较第1天ALB和TF显著升高(均P<0.01),负氮平衡转为正氮平衡(P<0.01);谷氨酰胺营养组的ALB和TF在治疗第7天、第14天均显著高于常规肠内营养组(均P<0.01)。结论谷氨酰胺强化的早期肠内营养可明显改善重型颅脑损伤患者的免疫功能和蛋白质营养代谢。Objective To investigate the effects of early enteral nutrition（EEN） and glutamine-supplemented EEN on the immune function and nutritional metabolism in old patients with severe brain injury. Methods 60 patients were randomly divided into two groups, normal enteral nutrition group （ control group） and glutamine-supplemented EEN group （experimental group）. APACHE-I1 score was used to evaluate the patients after admission. Blood samples were collected on day 1,7, 14 after admission for IgA, IgG, IgM, and Tlymphoeyte subsets ; meanwhile, the albumin（ ALB）, transferring （TF） and nitrogen balance（NB） were also measured. Results IgA, IgG, CIM~ ,CD8~ value and CD4~/CD8~ ratio in both two groups were significantly higher on day 7,14 than that on day 1 （ P 〈 0. O1 ）, and the values of experimental group on day 7,14 after treatment were significantly higher than control group on day 7,14（ P 〈 0.01 ）. ALB and TF were significantly increased in two groups after treatment（ P 〈 0.01 ）, negative nitrogen balance converted to positive nitrogen balance （ P 〈 O. O1 ） ; ALB and TF values of experimental group on day 7,14 were significantly higher than control group. Conclusion Glutamine-supplemented EEN can obviously improve the immune function and nutritional metabolism in old patients with severe brain injury.

关 键 词：重型颅脑损伤 谷氨酰胺 肠内营养 免疫功能 蛋白质代谢 

分 类 号：R651.15[医药卫生—外科学] R459.3[医药卫生—临床医学]