谷氨酰胺强化肠内营养支持对重型颅脑损伤患者的临床疗效  

Clinical Effect of Glutamine Enhanced Enteral Nutrition Support on Severe Head Injury Patients

作　　者：曹淑芳 陈春阳[1] 李秋红[1] CAO Shu-fang;CHEN Chun-yang;LI Qiu-hong(The First People's Hospital of Chenzhou,Hunan Chenzhou 423000)

机构地区：[1]郴州市第一人民医院,湖南郴州423000

出　　处：《深圳中西医结合杂志》2022年第5期15-18,共4页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:研究谷氨酰胺强化肠内营养支持对重型颅脑损伤(SHI)患者的炎症和肠道屏障功能的影响。方法:选取2018年6月至2020年12月郴州市第一人民医院收治的SHI患者94例,根据病历号均分为两组,对照组和观察组各47例。所有患者均给予常规治疗和早期肠内营养,观察组在肠内营养的基础上添加谷氨酰胺。比较两组患者临床治疗有效率,以及14 d时两组患者营养水平、炎症因子、肠道屏障功能及并发症发生情况。结果:观察组患者治疗总有效率为82.98 %,显著高于对照组的61.70 %,差异具有统计学意义(P<0.05);治疗14 d时,两组患者白蛋白(ALB)、血清总蛋白(TP)、转铁蛋白(TRF)、格拉斯哥昏迷量表(GCS)评分均较治疗前显著上升,而对照组上臂肌围(AMC)及肱三头肌皮褶厚度(TSF)较治疗前显著减小,差异均具有统计学意义(P<0.05);治疗14 d时,观察组患者ALB、TP、TSF、TRF、AMC、GCS评分均比对照组高,差异具有统计学意义(P<0.05)。治疗14 d时,两组患者可溶性髓样细胞触发受体–1(sTREM–1)、白细胞介素–6(IL–6)、肿瘤坏死因子–α(TNF–α)水平均较治疗前显著下降,且观察组sTREM–1、IL–6、TNF–α水平比对照组低,差异均具有统计学意义(P<0.05)。治疗14 d时,两组患者二胺氧化酶(DAO)、降钙素原(PCT)、D–乳酸水平均较治疗前显著下降,且观察组DAO、PCT、D–乳酸水平比对照组低,差异均具有统计学意义(P<0.05)。观察组患者胃肠道不适及肺部感染发生率均低于对照组,差异具有统计学意义(P<0.05)。结论:在SHI患者肠内营养中添加谷氨酰胺可以保护肠黏膜屏障结构和功能,抑制炎症介质释放,减少并发症和感染发生。Objective To investigate the effects of glutamine supplementation on inflammation and intestinal barrier function in patients with severe head injury (SHI).Methods A total of 94 cases of SHI patients admitted to the First People’s Hospital of Chenzhou from June 2018 to December 2020 were selected and divided into two groups according to their medical records,with 47 cases in the control group and 47 cases in the observation group.All patients received conventional treatment and early enteral nutrition,while the observation group received glutamine in nutrient solution.The clinical treatment efficiency of the two groups,as well as the nutritional levels,inflammatory factors,intestinal barrier function and complications were compared between the two groups on the 14th day of treatment.Results The total effective rate of the observation group was 82.98%,which was significantly higher than 61.70% of the control group (P < 0.05).After 14 days of treatment,the levels of albumin (ALB),serum total protein (TP),transferrin (TRF) and the score of Glasgow Coma Scale (GCS) in two groups were significantly increased compared with those before treatment,while upper arm muscle circumference (AMC) and triceps skin fold thickness (TSF) in the control group were significantly decreased compared with those before treatment.The differences were statistically significant (P < 0.05).After 14 days of treatment,ALB,TP,TSF,TRF,AMC and GCS scores in the observation group were higher than those in the control group,the differences were statistically significant (P < 0.05).After 14 days of treatment,the levels of soluble triggering receptor-1 (sTREM-1),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were significantly decreased compared with those before treatment,and the levels of sTREM-1,IL-6 and TNF-α in the observation group were lower than those in the control group.The differences were statistically significant (P < 0.05).On the 14th day of treatment,the levels of diamine oxidase (DAO),procalcitonin (PC

关 键 词：重型颅脑损伤 谷氨酰胺 肠黏膜 肠道屏障功能 

分 类 号：R651.15[医药卫生—外科学]