谷氨酰胺联合肠内营养治疗重症急性胰腺炎的临床观察  

Clinic study for early enteral nutrition supplemented with glutamine for patients with severe acute pancreatitis

作　　者：周瑞祥[1] 

机构地区：[1]武汉市第一医院ICU内科,湖北武汉430022

出　　处：《中国急救医学》2013年第4期310-313,共4页Chinese Journal of Critical Care Medicine

基　　金：武汉市卫生局临床医学科研项目（WX11A01）

摘　　要：目的研究谷氨酰胺联合早期肠内营养（EN）对重症急性胰腺炎（SAP）的治疗作用。方法将60例重症急性胰腺炎患者采用随机数字表法分为3组：肠外营养组（PN组）、肠内营养组（EN组）和肠内营养＋谷氨酰胺组（EN＋Gln组）。3组患者均于治疗前及治疗后5d和10d分别取血测定血清中的谷氨酰胺、内毒素、白蛋白（ALB）、前白蛋白（PAB）、转铁蛋白（TF）、CD3、CD4、CD8、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的水平，并统计3组患者感染率、死亡率、转手术率、MODS发生率、平均住院时间、平均住院费用。结果①营养治疗后10d，3组患者血清Gin水平均升高，EN＋Gin组明显高于TPN组和EN组（P〈0．05）；@PN组患者LPS逐渐升高，而EN组和EN＋Gln组患者LPS逐渐下降，与治疗前比较差异均有统计学意义（P〈0．05）；EN＋Gln组较EN组下降更明显（P〈0．05）；③营养治疗后，3组患者CD3、CD4、CD8、CD4／CD8逐渐升高；治疗后10d，EN组高于PN组，EN＋Gln组高于EN组，差异有统计学意义（P〈0．05）；④营养治疗后，3组患者CRP、IL-6、TNF逐渐降低；治疗后10d，EN组低于PN组，EN＋Gin组低于EN组，差异有统计学意义（P〈0．05）；⑤在感染率、MODS发生率、平均住院时间及平均住院费用方面，EN组低于PN组，EN＋Gin组低于EN组，差异均有统计学意义（P〈0．05）。结论谷氨酰胺联合早期EN可以改善SAP患者营养代谢和免疫功能，促进消化道功能的恢复，阻止细菌和内毒素的移位，减少炎性反应，其作用优于单纯肠内免疫营养。Objective To research the effect of early enteral nutrition （EN）supplemented with glutamine（Gln） for the patients with severe acute pancreatitis（SAP）. Methods 60 patients with SAP were randomly divided into three groups, parenteral nutrition group （ PN group, 20 cases ）, enteral nutrition group（ EN group, 20 cases）and EN ＋Gln group（ EN ＋ Gin group, 20 cases）. Before nutrition treatment and then 5 and 10 days after treatment, blood samples were collected for analysis of glutamine, endotoxin （LPS） , albumin （ ALB ）, pre - albumin （ PAB）, transferrin （ TF）, CD3, CIM, CD8, C - reactive protein （ CRP）, interleukin - 6 （ IL - 6 ）, tumor necrosis factor - α （ TNF - α）. Meanwhile, the infection rate, the death rate, the operation rate, MODS rate, length of stay and cost of hospitalization were measured. Results ①10 days after treatment, for the level of Glutamine, EN group were higher than PN group, and EN ＋ Gin group were higher than EN group （ all P 〈 0.05 ） ; ②for PN group, the level of endotoxin after treatment was higher than Before treatment; for EN and EN ＋ Gin group, the level of endotoxin after treatment was lower than before treatment, and EN ＋ Gin group were lower than EN group（ all P 〈 0.05） ; ③10 days after treatment, for the level of CD3, CD4, CD8 and CD4/CD8, EN group were higher than PN group, and EN ＋ Gin group were higher than EN group （ all P 〈 O. 05 ） ; ④10 days after treatment, for the level of CRP, IL - 6 and TNF - α, EN group were lower than PN group, and EN ＋Gln group were lower than EN group（ all P 〈0.05） ; ⑤for the infection rate, MODS rate, length of stay and cost of hospitalization, EN group were lower than PN group, and EN ＋ Gin group were lower than EN group （ all P 〈 0.05）. Conclusion For the patients with severe acute pancreatitis, EN combined with Gin can improve body nutritional condition and Immunological function, promote recovery of digestive function, prevent the bacterial a

关 键 词：重症急性胰腺炎(SAP) 肠内营养(EN) 谷氨酰胺(Gln) 免疫功能 

分 类 号：R735.1[医药卫生—肿瘤]