视黄醇结合蛋白检测及谷氨酰胺应用在严重脓毒症营养支持治疗中的价值

目的探讨视黄醇结合蛋白检测及谷氨酰胺应用在严重脓毒症患儿营养支持治疗中的价值。方法108例严重脓毒症患儿机体状况给予相应的营养支持，选择肠内营养（EN）或肠外营养（PN），或同时给予EN和PN，PN组分谷氨酰胺（GIn）组和非Gln组。对视黄醇结合蛋白（RBP）、血清白蛋白（AI。B）、24h尿尿素氮、小儿危重症评分（PCIS）、患儿多器官功能障碍（MODS）数目、机械通气时间、存活和死亡患儿的危重评分（PCIS）及其器官受累数目，以及两组患儿的基础营养指标和代谢指标进行监测；并对存活患儿营养支持前0d、营养支持第3天和第7天的血清RBP、PA、ALB、Hb水平等进行比较。结果存活组患儿营养支持10d内热卡明显高于死亡组。存活组患儿PN时Gln组免疫球蛋白明显高于非Gln组，氮平衡状况也好于非Gln组。EN组与PN＋EN组在治疗0d、3d时营养指标RBP、PA及氮平衡比较差异均有显著性（P〈0．05），而ALB、Hb差异无统计学意义（P〉0．05）。7d后两组各项指标比较差异无显著性（P〉0．05）。死亡患儿的PCIS评分低于存活患儿，而器官受累数目多于存活组。存活儿与死亡患儿机体代谢状况及体液免疫指标比较差异有显著性（P〈0．05）。EN组患儿住PICU时间与机械通气时间较PN＋EN组患儿短（P〈0．05）。结论严重脓毒症患儿机体表现为代谢率明显升高，能量消耗明显增加，蛋白分解利用大于合成，早期即出现血清RBP、PA水平的降低，呈现明显负氮平衡；病情越重，机体代谢指标、营养指标、免疫球蛋白水平等越低。时严重脓毒症患儿进行营养支持时加用Gln显得尤为重要。

The value of nutritional support with Retinol-binding protein assay and use of Glutamine in Severe sepsis

Objective To explore the value of nutritional support with Retinol-binding protein as- say and use of Glutamine in Severe sepsis. Methods Total of 108 cases of children with severe sepsis given corresponding nutrition support according to the different condition and the body status, to choose enteral nutrition （EN） or parenteral nutrition （PN） ,or given EN and PN at the same time. All patients were monitored by the standardized index,and also were monitored the PCIS of the survival group and the dead group, the numbers of involved organs, nutrition indexes and metabolism indexes of the two groupsl compared the indexes such as serum prealbumin （PA）, retinal-binding protein （RBP）, serum albumin （Alb）, hemoglobin （Hb）, etc, of survived children before nutrition support 0d, with nutrition support 3d and 7d. Results Compared with the dead group,the level of internal calories after 10d＇s nutrition support were significantly higher than in the survival group. Among the survival groups with parenteral nutrition,compared with non-Gln group,the level of immunoglobulin were sig- nificantly higher than in Gln group. After 0d and 3d＇s treatment, there were statistically significant differences （P~0.05） in the nutrition indexes such as serum prealbumin （PA）, retinal-binding protein （RBP） and nitrogen balance between the EN group and ENd-PN group,and the same time, there were no statistically significant difference （P：〉0.05） in the nutrition indexes, such as serum albumin （Alb） and hemoglobin （Hb）. After 7d＇s treatment, there were no significantly differences between the two groups（P〈0.05）. The dead group＇s PCIS were lower than the survival group＇s, but numbers of in- volved organs were more. There were significantly differences of the body＇s metabolic state and humor- al immune parameters between the two groups. Compared with the EN-kPN group,the time in PICU and time of mechanical ventilation were significantly shorter in the EN group （P〈0.05）. Conclusion The children with the more severe sepsis have the lower metabolic indexes,nutrition indexes,immuno- globulin,etc. It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition,and it is very important to choose EN or PN as individualized nutrition support treatment based on children＇s condition.