脓毒血症患者应用丙氨酰谷氨酰胺双肽强化早期肠内营养治疗的临床研究-中国药房

脓毒血症患者应用丙氨酰谷氨酰胺双肽强化早期肠内营养治疗的临床研究

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篇名：	脓毒血症患者应用丙氨酰谷氨酰胺双肽强化早期肠内营养治疗的临床研究
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摘要：	目的：探讨脓毒血症患者早期应用丙氨酰谷氨酰胺双肽强化早期肠内营养（EN）支持治疗对其营养学指标、免疫指标、肝肾功能指标及并发症的影响。方法：选取我院2013年5月－2015年1月收治的112例脓毒血症患者，采用随机数字表法分为观察组和对照组，各56例。两组患者均接受常规抗菌治疗，同时进行早期（48 h）EN支持，每天氮补充量为0.2 g/kg，热量25 kcal/kg，非蛋白热量19～21 kcal/kg；观察组患者加用注射用丙氨酰谷氨酰胺0.5 g/kg加入0.9％氯化钠注射液100 mL中，24 h内持续泵人，疗程4 d。比较两组患者治疗前后营养学指标[血清白蛋白（ALB）、前白蛋白（PAB）、血红蛋白（Hb）]，免疫指标[C反应蛋白（CRP）、免疫球蛋白（Ig）G、IgA、IgM]水平，急性生理与慢性健康（APACHEⅡ）评分，器官功能衰竭（SOFA）评分，以及肝肾功能[丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血肌酐（Cr）、尿素氮（BUN）水平]，并观察两组患者预后及并发症的发生情况。结果：治疗前，两组患者ALB、PAB、Hb、CRP、IgG、IgA、IgM、APACHEⅡ评分、SOFA评分、ALT、AST、Cr、BUN水平比较，差异均无统计学意义（P＞0.05）。治疗后，观察组患者ALB、PAB水平较治疗前显著升高，且观察组显著高于对照组，差异有统计学意义（P＜0.05）；两组患者APACHEⅡ评分、SOFA评分较治疗前显著降低，且观察组显著低于对照组，差异均有统计学意义（P＜0.05）；两组患者的CRP显著降低，IgG显著升高，且观察组显著优于对照组，差异均有统计学意义（P＜0.05）；两组患者的Cr、BUN水平较治疗前均显著降低，且观察组Cr水平显著低于对照组，差异均有统计学意义（P＜0.05）。观察组患者的重症监护病房停留时间、呼吸机使用时间、抗菌药物使用时间均显著短于对照组，腹泻和胃潴留发生率均显著低于对照组，差异均有统计学意义（P＜0.05）。结论：脓毒血症患者早期应用丙氨酰谷氨酰胺双肽强化的早期EN支持治疗能够显著改善患者免疫功能和肝肾功能，减少并发症的发生。
ABSTRACT：	OBJECTIVE： To investigate the effects of alanyl-glutamine dipeptide-intensified early enteral nutrition （EN） support on nutritional indexes， immune indexes， renal indexes and complications of sepsis patients. METHODS： A total of 112 cases of sepsis admitted into our hospital during May 2013-Jan. 2015 were selected and divided into observation group and control group according to random number table， with 56 cases in each group. Both groups received routine antibiotic therapy and early EN support （48 h） with nitrogen supplement 0.2 g/kg， calories 25 kcal/kg and nonprotein calories 19-21 kcal/kg each day. Observation group was additionally given Alanyl-glutamine for injection 0.5 g/kg with 0.9％ sodium chloride injection 100 mL， continuous pump within 24 h， for 4 d. The levels of nutritional indexes （ALB， PAB， Hb）， immune indexes （CRP， IgG， IgA and IgM）， APACHEⅡ scores， SOFA scores， liver and renal function indexes （the levels of ALT， AST， Cr and BUN） were compared between 2 groups before and after treatment. The prognosis and the occurrence of complication were also observed in 2 groups. RESULTS： Before treatment， there was no statistical significance in the levels of ALB， PAB， Hb， CRP， IgG， IgA， IgM， ALT， AST， Cr， BUN and APACHEⅡ scores， SOFA scores between 2 groups （P＞0.05）. After treatment， the levels of ALB and PAB in observation group were increased significantly compared to before treatment， and the observation groups was significantly higher than control group， with statistical significance （P＜0.05）. APACHEⅡ score and SOFA score of 2 groups were decreased significantly compared to before treatment， and the observation group was significantly lower than the control group， with statistical significance （P＜0.05）. CRP of 2 groups were decreased significantly while IgG were increased significantly； the observation group was significantly better than the control group， with statistical significance （P＜0.05）. Cr and BUN levels of 2 groups were decreased significantly compared to before treatment， and the level of Cr in observation group was significantly control group， with statistical significance （P＜0.05）. The time of ICU stay， ventilator supporting time and antibiotics application time in observation group were significantly shorter than control group， and the incidence of diarrhea and gastric retention were significantly lower than control group， with statistical significance （P＜0.05）. CONCLUSIONS： Alanyl-glutamine dipeptide-intensified early EN support can significantly improve immune function and liver and renal function of sepsis patients and reduce the occurrence of complications.
期刊：	2017年第28卷第14期
作者：	张风芝，李庆方
AUTHORS：	ZHANG Fengzhi，LI Qingfang
关键字：	脓毒血症；丙氨酰谷氨酰胺双肽强化；肠内营养；免疫功能
KEYWORDS：	Sepsis； Alanyl-glutamine dipeptide-intensified； Enteral nutrition； Immunity function
阅读数：	318 次
本月下载数：	2 次

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