谷氨酰胺对重症颅脑外伤患者炎性反应的影响研究  

Study on influence of glutamine on inflammatory response in patients with severe craniocerebral trauma

作　　者：申林[1] 张合亮[2] 郑平[3] 

机构地区：[1]天津市泰达医院营养科,天津300457 [2]天津市第三中心医院营养科,天津300480 [3]天津市泰达医院神经科,天津300457

出　　处：《中华医院感染学杂志》2014年第12期3011-3013,共3页Chinese Journal of Nosocomiology

基　　金：天津市滨海新区卫生局科技攻关基金项目(2012BWKL006)

摘　　要：目的探讨谷氨酰胺对重症颅脑外伤患者炎性反应的影响,了解谷氨酰胺对预防医院感染发生的效果。方法收集2011年12月-2013年10月就诊的重症颅脑外伤患者90例,采用随机分组的方法随机分为对照组和观察组,每组各45例,对照组给予常规肠内营养支持,观察组患者则给予添加谷氨酰胺加强肠内营养支持,两组患者其他治疗方法相同,观察两组患者治疗前和治疗后第10天的细胞因子和C-反应蛋白炎性指标的变化,比较营养代谢指标和免疫指标,并记录两组患者在住院期间医院感染发生情况;采用SPSS13.0统计软件进行资料分析。结果观察组患者在治疗后的细胞因子数据显示,血清白介素-2(IL-2)、IL-6、IL-8、IL-10浓度和CRP浓度显著低于对照组(P<0.05);血转铁蛋白和前白蛋白、IgA、IgG、IgM的结果两组患者差异均有统计学意义(P<0.05);观察组15例患者发生感染,感染持续(8.27±5.02)d,对照组19例患者发生感染,感染持续(10.24±5.30)d,观察组感染例数少于对照组,组间比较差异无统计学意义,但观察组感染患者的感染天数明显低于对照组(P<0.05)。结论加入谷氨酰胺肠内营养支持,可以减轻重症颅脑外伤患者的炎性反应,提高细胞免疫功能,对预防医院感染的发生有良好的效果,从一定程度上提高了患者的生存率。OBJECTIVE To study the influence of glutamine on the inflammatory response in patients with severe craniocerebral trauma and to learn about the effect of glutamine on preventing nosocomial infections .METHODS A total of 90 patients with severe craniocerebral trauma who visited for diagnosis from Dec 2011 to Oct 2013 were collected and divided into control group and observation group randomly ,with 45 patients in each group ;the control group was given conventional enteral nutrition support ,while the observation group was given glutamine to strengthen the enteral nutrition support ;the other treatment methods for both of the two groups were the same . The changes of cytokines and C-reactive proteins before the treatment and 10 days later after treatment were observed ,the nutrition metabolism parameters and immunity parameters were compared between the two groups , and the occurrence of nosocomial infections of patients in the two groups during hospitalization was recorded ;SPSS 13 .0 software was adopted for data analysis .RESULTS The data of cytokines in observation group after treatment showed that the concentrations of serum interleukin-2 （IL-2 ） , IL-6 , IL-8 ,and IL- 10 and CRP concentration were significantly lower than that of control group （P〈0 .05） .There was significant difference in the serum transferrin ,prealbumin ,IgA ,IgG and IgM results of the two groups of patients （P〈 0 .05）;in the observation group ,15 patients suffered infections ,which continued for （8 .27 ± 5 .02） d;in the control group ,19 patients suffered infections ,which continued for （10 .24 ± 5 .30） d;the number of infected patients was less than that in the observation group ,and there was no significant difference between the two group ;however ,the infection days of the observation group was significantly less than that of the control group （ P〈 0 .05 ） . CONCLUSION Addition of glutamine to enteral nutrition support could alleviate inflammatory response in patients with severe craniocerebral trauma

关 键 词：谷氨酰胺 重症颅脑外伤 炎性反应 医院感染 免疫指标 

分 类 号：R181.32[医药卫生—流行病学]