不同剂量精氨酸强化的肠内营养对创伤危重患者的支持作用  

Support the effects of different doses of arginine enriched enteral nutrition for patients with severe trauma

作　　者：郭丽娜[1] 张文青[2] 安阳[1] 刘娟[1] 郝丹丹[1] 

机构地区：[1]山西医科大学公共卫生学院营养与食品卫生教研室,太原030001 [2]山西医科大学第二临床医院营养科,太原030001

出　　处：《中华临床医师杂志（电子版）》2015年第7期8-11,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：中国医师协会临床营养发展基金(CN2012004)

摘　　要：目的探讨不同剂量精氨酸强化的肠内营养对创伤危重患者的支持作用。方法选择骨科创伤危重患者（简明创伤评分AIS为3～10分）60例,随机分为对照组和试验Ⅰ、Ⅱ、Ⅲ组,在经口肠内营养支持的基础上,分别给予精氨酸0 g·kg^-1·d^-1、0.1 g·kg^-1·d^-1、0.3 g·kg^-1·d^-1、0.5 g·kg^-1·d^-1,连续作用14 d,观察患者胃肠道耐受和创口感染情况,于作用前后检测营养指标（总蛋白、前白蛋白、血清白蛋白）、免疫指标（Ig A、Ig G、Ig M）,并记录住院时间。结果与对照组相比,试验Ⅰ、Ⅱ、Ⅲ组前白蛋白升高在干预第8天、第15天显著（P〈0.05）;试验Ⅱ、Ⅲ组血清白蛋白、总蛋白升高在干预第8天、第15天显著（P〈0.05）,而Ig A、Ig G改善只在干预第15天具有统计学意义（P〈0.05）,且两组患者创口感染改善明显,住院时间显著缩短。结论精氨酸强化的肠内营养可改善创伤危重患者的营养、免疫状况及创口感染,其中添加0.3 g·kg^-1·d^-1精氨酸组效果最佳。Objective To investigate the role of support different doses of arginine enriched enteral nutrition for patients with severe trauma. Methods Select orthopedic trauma in critically ill patients（concise trauma score AIS is 3 to 10） 60 cases, were randomly divided into control group and experimen Ⅰ, Ⅱ, Ⅲ group, based on oral enteral nutrition support, in proper order give the arginine 0 g·kg^-1·d^-1, 0.1 g·kg^-1·d^-1, 0.3 g·kg^-1·d^-1, 0.5 g·kg^-1·d^-1, work 14 days in a row, observed the patients with gastrointestinal tolerance and wound infection situation, before and after testing, detected the nutrition indexes（TP, PA, ALB）, immune index（Ig A, Ig G, Ig M） and record the time of hospitalization.Results Compared with control group, experimental Ⅰ, Ⅱ, Ⅲ group PA significantly increased in the intervention of eighth, fifteenth days（P〈0.05）; experiment II, III group TP, ALB significantly increase in the intervention of eighth, fifteenth days increased（P〈0.05）, while Ig A, Ig G improved only in the intervention for fifteenth days with statistical significance（P〈0.05）, and the two groups of patients with wound infection were improved obviously, significantly shorten the hospitalization time. Conclusion Arginine enhanced enteral nutrition can improve bone in critically ill patients with nutrition, immune status and wound infection, the addition of 0.3 g·kg^-1·d^-1 arginine group has the best effect.

关 键 词：精氨酸 肠道营养 创伤和损伤 

分 类 号：R641[医药卫生—外科学]