不同途径补充谷氨酰胺对重症烧伤患者能量摄入和预后的影响  

Effect of glutamine on energy intake and prognosis of severe burn patients in different pathway

作　　者：王宏宇[1] 王超[1] 胡建红[1] 彭曦[1] 

机构地区：[1]第三军医大学西南医院烧伤研究所,重庆400038

出　　处：《重庆医学》2015年第25期3511-3513,共3页Chongqing medicine

摘　　要：目的研究不同途径补充谷氨酰胺(Gln)对重症烧伤患者能量摄入和预后的影响。方法采用回顾性研究方法,从2010年10月至2014年4月该科入院患者中选择符合入选标准的66例为研究对象。将伤后第5天开始通过胃肠途径给予Gln的患者纳入肠内补充Gln组(n=31);伤后5d以后仍通过静脉给予Gln的患者纳入肠外补充Gln组(n=35)。观察患者伤后1、2、3、4周能量摄入总量及比例、能量摄入/热量消耗比值、血糖控制情况及胰岛素使用量以及脏器损伤指标(血肌酐、尿素氮、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、肌酸激酶同工酶、乳酸脱氢酶)、病死率、ICU住院时间和总住院时间等指标。结果在伤后1个月内,肠内补充Gln组患者能量摄入高于肠外补充Gln组,且通过胃肠获得的能量明显高于肠外补充Gln组,此外,ICU住院日明显低于肠外补充Gln组(P<0.05)。两组糖、脂肪、蛋白质等供能比例,血糖控制情况及胰岛素用量,脏器损伤指标,总住院时间及病死率差异均无统计学意义(P>0.05)。结论经胃肠途径补充谷氨酰胺可能更加有利于改善烧伤患者肠道功能,提高肠内营养的耐受程度,增加患者能量摄入,有利于改善患者预后。Objective To investigate the effect of glutamine on energy intake and prognosis of severe burn patients in different pathway. Methods Using retrospective study method,we brought the patients into our study from October 2010 to April 2014 in accordance with the inclusion criteria. Patients who were given the Gln before 5 days after injury through gastric bowel were brought into the EN group,others who were given the Gln after 5 days after the injury through vein were brought into PN groups. A total of 66 patients were included in this study,with 31 cases of EN group and 35 cases of PN group. Total energy intake, external and internal energy intake, nutrients heating, energy intake/energy consumption ratio, blood glucose control, insulin use and viscera damage （the blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, total bilirubin, creatine kinase, lactate dehydrogenase）, ICU days, hospital stays and mortality were observed in 1,2,3,4 weeks after injury. Results Within a month after the injury, the energy intake of patients in EN group were more than PN group, especially the energy from intestinal canal. Besides,the ICU days of patients in EN group were shorter than patients in PN group （all P〈0.05）. Other indicators of two groups of patients were no significant statistical difference（P〉0.05）. Conclusion Supplement of Gln may be more conducive to improve the intestinal function in patients with burns may be more conducive to improve the intestinal function in patients with burns, improve the degree of tolerance of enteral nutrition,increase energy intake and conducive to improving the prognosis of patients.

关 键 词：谷氨酰胺 重度烧伤 肠内营养 肠外营养 能量摄入 

分 类 号：R644[医药卫生—外科学]