含不同剂量谷氨酰胺肠内营养对老年危重患者氧化应激状态的影响

目的探讨给予不同剂量谷氨酰胺的肠内营养对老年危重患者氧化应激状态的影响。方法将90例老年危重患者随机分成3组：不含谷氨酰胺的完全胃肠外营养组（A组），低剂量谷氨酰胺（0．3g·kg-1·d-1）肠内营养组（B组），高剂量谷氨酰胺（0．6g·kg-1·d-1）肠内营养组（C组）。于营养支持的第1天、第7天、第14天清晨采集空腹静脉血，测定血清丙二醛（MDA）、超氧化物歧化酶（SOD）及谷胱甘肽过氧化物酶（GSH—PX），观察患者氧化应激的水平变化，同时比较急性生理学与慢性健康状况评分系统Ⅱ（APAcHEII）和C-反应蛋白（CRP）的变化。结果含有谷氨酰胺的肠内营养组（B、C组）MDA于营养支持后的第7天均出现降低（P〈0．05），第14天时高剂量的谷氨酰胺C组下降更明显（P〈0．05）。低剂量B组sOD于第7天就出现上升（P〈0．05），高剂量C组于第14天时上升（P〈0．05）。GSH—PX在营养支持后有所上升，但未出现统计学上的差异俨〉0．05）。B、C组的APACHE1I评分和CRP均于营养支持后的第7天出现下降（P〈0．05），第14天时，C组继续出现下降（P〈0．05）。结论含谷氨酰胺的肠内营养能改善老年危重患者的氧化应激状态，含高剂量的谷氨酰胺肠内营养改善的程度更为明显。

Effects of enteral nutrition with different doses of glutamine on oxidative stress in elderly critically ill patients

Objective To study the effects of enteral nutrition with different doses of glutamine on oxidative stress in eldely critically ill patients. Methods Ninety critically ill patients were randomly divided into three group： total parenteral nutrition without glutamine group （group A）, enteral nutrition with low and high glutamine （0.3 g·kg-1·d-1 and 0.6 g·kg-1·d-1） groups （group B and C）. The fasting blood samples were collected before nutrition support early in the morning on the first, seventh and fouteenth day. Serum malondialdehyde （MDA）, superoxide dismutase （SOD） and glutathione peroxidase （GSH- PX） were measured. And acute physiology and chronic health evaluation II （APACHE II ） and C-Reactive Protein （CRP） were also estimated at the same days. Results The serum levels of MDA in group B and C were significantly lower than those of in group A （P〈 0.05 ） on the seventh day. And the serum levels of MDA in group C were significantly lower than those of in group A on the fourteenth day （P 〈 0.05 ）. The serum levels of SOD in group B and C were significantly higher than those of in group A on the seventh day. SOD levels in C group were significantly higher on fourteenth day （P〈0.05）, GSH-PX levels were increased but no statistical differences （P〉0.05） among three groups. APACHE II and CRP levels were all decreased in three groups but mostly in group B and C （P〈0.05）. Conclusion Enteral nutrition with glutamine can improve oxidative stress capability in elderly critically ill patients, especially with high doses of glutamine.