危重型胰腺炎全身炎症采用谷氨酰胺联合早期肠内营养治疗的临床效果

目的 探讨采用谷氨酰胺联合早期肠内营养治疗危重型胰腺炎对患者炎症反应的影响.方法 在2014年6月至2016年4月期间本院收治的危重型胰腺炎患者中选取82例,按照治疗方案的不同将其分为观察组和对照组,其中对照组患者仅接受肠外营养,观察组患者则采用早期肠内营养联合谷氨酰胺进行治疗,对两组患者炎症反应、氨基酸代谢情况进行观察分析.结果 观察组患者在治疗后MCP-1[(25.3±3.4) ng/ml]、HMGB-1[(6.7±0.9) ng/ml]水平均明显低于对照组[(41.2±6.3) ng/ml、(10.5±1.7)ng/ml],差异有统计学意义(P＜0.05);观察组患者在治疗结束后,其血清苏氨酸[(11.2±1.5) μmol/L]、苯丙氨酸[(4.3±0.6)μmol/L]、缬氨酸[(4.9±0.7) μmol/L]及赖氨酸[(6.6±0.8)μmol/L]水平均明显高于对照组[(7.6±0.9)μmol/L、(2.3±0.4)μmol/L、(3.5±0.4)μmol/L、(2.7±0.3)μmol/L],差异有统计学意义(P＜0.05).结论 采用早期肠内营养联合谷氨酰胺治疗危重型胰腺炎,可有效促进患者蛋白质合成的改善,有助于缓解机体负氮平衡,并有利于促进患者全身炎症反应的缓解,建议在临床推广应用.

Clinical effect of glutamine combined with early enteral nutrition on systemic inflammation in critically ill patients with acute pancreatitis

Objective To investigate the effect of glutamine combined with early enteral nutrition on the inflammatory response in patients with severe pancreatitis.Methods From June 2014 to April 2016,82 patients with severe acute pancreatitis admitted in our hospital were divided into observation group and control group according to the different treatment regimen.The patients in the control group underwent parenteral nutrition only,while the patients in the observation group underwent early enteral nutrition combined with glutamine.The inflammatory response,amino acid metabolism of the two groups were observed and analyzed.Results After treatment,the levels of MCP-1 [(25.3±3.4)ng/ml],HMGB-1 [(6.7±0.9)ng/ml] in the observation group were significantly lower than those in the control group [(41.2±6.3)ng/ml,(l 0.5± 1.7)ng/ml],with statistically significant differences (P＜0.05).After treatment,the levels of serum threonine [(I 1.2±1.5)μmol/L],phenylalanine [(4.3±0.6) μmol/L],valine [(4.9±0.7)μtmol/L],and lysine [(6.6±0.8)μtmol/L] in the observation group were significantly higher than those in the control group [(7.6±0.9)μmol/L,(2.3±0.4)μtmol/L,(3.5±0.4)μmol/L,(2.7±0.3)μmol/L],with statistically significant differences (P＜0.05).Conclusion Early enteral nutrition combined with glutamine in the treatment of critical pancreatitis,can effectively promote the improvement of protein synthesis in patients,helps to alleviate the body negative nitrogen balance and systemic inflammatory response,which is recommended in clinical application.