谷氨酰胺双肽强化肠外营养在ICU患者中的应用效果评价

Efficacy of glutamine dipeptide-enhanced parenteral nutrition in ICU patients

关键词:  谷氨酰胺双肽制剂  肠外营养  重症监护室

Key words:  glutamine dipeptide  parenteral nutrition  intensive care unit

摘要:

目的　探讨重症监护室（intensive care unit, ICU）患者应用丙氨酰-谷氨酰胺制剂强化肠外营养的临床效果。方法　将2018年6月—2019年12月同济大学附属第十人民医院ICU病房需要实施肠外营养的54例患者作为研究对象，采用随机对照法将研究对象分为实验组（谷氨酰胺双肽强化肠外营养组）28例和对照组（常规肠外营养组）26例。比较两组患者实验第1天和第10天营养指标、免疫指标、肠黏膜屏障功能及临床结局等的差异。结果　两组患者的基本信息、体质量指数、病种、APACHE Ⅱ评分、肝肾功能、血糖水平等差异无统计学意义（P>005）；入院第10天，实验组血清C反应蛋白、感染发生率较对照组显著降低（P<005）；实验组前白蛋白、转铁蛋白、白蛋白、CD4+、CD8+较对照组显著增加（P<005）；实验组二胺氧化酶、D-乳酸及内毒素较对照组明显降低（P<005）；住院期间，实验组呼吸机辅助天数、住院天数、住院病死率较对照组降低，但差异无统计学意义（P>005）。结论　ICU患者肠外营养添加谷氨酰胺双肽制剂有助于改善患者营养状态，降低炎症反应，提高机体免疫水平，维持肠黏膜屏障，但在改善临床结局方面效果不显著。

Abstract:

Objective　To evaluate the clinical efficacy of parenteral nutrition supplemented with glutamine in ICU patients. Methods　A randomized controlled trial was conducted on 54 patients who received parenteral nutrition in ICU of Shanghai Tenth Peoples Hospital from June 2018 to December 2019. The subjects were divided into intervention group（n=28） and control group（n=26） according to whether glutamine was added during parenteral nutrition. The differences of nutritional indicators, immune indicators, intestinal mucosal barrier function and clinical outcomes of two groups were compared before and 10 d after intervention. Results　There were no significant differences in basic information, body mass index, disease type, APACHE Ⅱ score, liver and kidney function, and blood glucose level between the two groups（P>005). At D10 of admission, serum C-reaction protein and infection rate in the intervention group were significantly lower than those in the control group（P<005); while pre-albumin, transferrin， albumin and CD4+, CD8+ levels in the intervention group were significantly increased（P<005). Diamine oxidase, D-lactic acid and endotoxin in intervention group decreased significantly（P<005). Compared with control group, the length of ventilator days, length of hospital stay and fatality rate in the intervention group had the decreasing trend during hospitalization, but the difference was not statistically significant（P>005). Conclusion　The application of parenteral nutrition supplemented with glutamine dipeptide in ICU patients can improve nutrition status, relieve inflammatory reaction, enhance immunity, maintain intestinal mucosal barrier function, but there is no significant improvement in clinical outcomes.