摘要
目的探讨强化谷氨酰胺营养支持对老年危重症患者肠屏障功能及免疫功能的影响。方法回顾性分析2015年3月至2018年2月遂宁市中心医院重症监护室收治的84例老年危重症患者的临床资料,按照治疗方法分为观察组和对照组,每组各42例。对照组患者给予常规肠内营养支持,观察组患者在此基础上给予谷氨酰胺强化治疗,两组均治疗2周,比较两组患者治疗前后营养学指标变化、T淋巴细胞亚群水平、肠屏障功能指标变化,并记录两组患者营养支持后不良反应发生情况。结果观察组治疗后血白蛋白(ALB)(42.51±3.12 g/L)、前白蛋白(PA)(259.82±15.02 mg/L)、血红蛋白(Hb)(125.84±7.23 g/L)均高于对照组(P<0.05)。观察组治疗后CD3^+、CD4^+、CD4^+/CD8^+均高于对照组(P<0.05)。观察组患者治疗后血清二胺氧化酶(DAO)(0.95±0.08μmol/L)和尿乳果糖/甘露醇(L/M)(0.105±0.030)比值均低于对照组(P<0.05)。两组患者营养支持后不良反应发生率分别为14.3%(6/42)和19.0%(8/42),差异无统计学意义(P>0.05)。结论对老年危重症患者在肠内营养支持基础上辅以谷氨酰胺强化治疗,有助于进一步改善患者机体营养状况,并可改善机体免疫功能,提高肠黏膜屏障功能,且用药安全性较高。
Objective To explore the effects of enhanced Glutamine nutrition support on intestinal barrier function and immune function in elderly patients with critical illness. Methods The clinical data of 84 elderly critically ill patients admitted from March 2015 to February 2018 in the intensive care unit of Suining central hospital were analyzed. According to the treatment methods,the patients were divided into the observation group and the control group,with 42 cases in each group. The patients in the control group were given routine enteral nutrition support,and the patients in the observation group were treated with glutamine on this basis. The two groups were treated for 2 weeks. The changes of nutrition index,T lymphocyte subgroup and intestinal barrier function before and after treatment in the two groups were compared,and the adverse reactions were recorded in the two groups of patients after nutritional support. Results ALB,PA and Hb in the observation group were higher than those in the control group after treatment（ P〈0. 05）. After treatment,CD3^＋,CD4^＋ and CD4^＋/CD8^＋ in the observation group were higher than those in the control group（ P〈0. 05）. Serum DAO and urinary L/M ratio in the observation group after treatment were lower than those in the control group（ P〈0. 05）. The adverse reaction rates of the two groups after nutrition support were 14. 3%（ 6/42） and 19. 0%（ 8/42） respectively,and the comparison was not statistically significant（ P〉0. 05）. Conclusion The elderly critically ill patients in enteral nutrition support on the basis of intensive treatment with glutamine,helps to further improve the nutritional status,and can improve the body＇s immune function,improve the intestinal mucosal barrier function,and drug safety is higher.
作者
龚宇
夏洪韬
曹霖
刘家瑞
敬毅
温晓辉
刘方久
GONG Yu;XIA Hong - tao;CAO Lin(Department of Intensive Medicine,Suining Central Hospital,Suining Sichuang 629000,China)
出处
《临床和实验医学杂志》
2018年第16期1732-1735,共4页
Journal of Clinical and Experimental Medicine
基金
四川省卫计委科技项目(编号:18PJYY1394)
关键词
老年危重症患者
营养支持
谷氨酰胺
肠屏障功能
免疫功能
Elderly patients with critical illness
Nutrition support
Glutanfine
Intestinal barrier function
Inunune function
