四磨汤联合谷氨酰胺对老年危重症患者营养支持的辅助作用

目的：探讨四磨汤联合谷氨酰胺在老年危重症患者营养支持中的协同作用。方法将2010年5月至2012年5月收入我院 ICU 的124例老年危重症患者应用计算机随机分为对照组62例和治疗组62例，两组均在血流动力学稳定后实施营养支持，对照组实施常规的肠内营养（ EN）＋肠外营养（PN），治疗组实施四磨汤＋ EN 联合谷氨酰胺＋ PN，观察两组营养支持前后前白蛋白（PA）、血清总蛋白（TP）、转铁蛋白（TF）、血清白蛋白（ALB）的变化，并对两组患者肠鸣音恢复情况、并发症的发生率、抗生素使用时间及入住 ICU 的时间进行比较。结果两组营养指标治疗前比较差异均无统计学意义（ P 均＞0.05），治疗后治疗组前白蛋白（145.24±6.72）g/ L]、转铁蛋白（1.93±0.98）g/ L]、血清总蛋白（79.86±10.38）g/ L]、血清白蛋白（54.91±2.91）g/ L]均好于对照组（139.24±34.16）、（1.68±0.33）、（74.73±7.31）、（49.87±2.61）g/ L]，差异均有统计学意义（t 值分别为3.610、2.929、4.360、6.767，P 均＜0.05）；而且应激性溃疡、二重感染的发生率42％（26/62）、37％（23/62）]明显低于对照组59％（37/62），53％（33/62）]，差异均有统计学意义（χ2值分别为5.186、5.271，P 均＜0.05）；治疗组抗生素平均使用时间为（8.82±0.71）d，ICU 平均入住时间为（16.14±3.01）d，达到完全肠内营养时间为（6.90±1.01）d，较对照组（10.21±1.30）、（20.67±2.29）、（13.91±1.51）d]明显缩短，差异均有统计学意义（t 值分别为8.892、7.786、3.609，P 均＜0.05）；治疗组肠鸣音平均恢复时间为（26.8±3.6）h，第1次肛门排气时间平均（25.4±3.2）h，较对照组（38.4±4.8）、（37.6±4.9）h]明显提前，差异均有统计学意义（t 值分别为3.551、2.516，P 均＜0.05）。结论老年危重症患者在营养支持中采用中西医结合方式，应用四磨汤联合谷氨酰胺可以减少并发症，缩短 ICU 入住时间，尽早恢复肠道功能，尽快过渡到全肠内营养，降低治疗费用，有利于患者的康复。

The auxiliary effect of decoction of four-drug juice combined with glutamine on nutritional support in the elderly critical ill patients

Objective To explore the effect of decoction of four-drug juice plus glutamine on nutritional support in the elderly critically ill patients. Methods One hundred and twenty-four elderly critical ill patients in The First Hospital of Jilin University from May 2010 to May 2012 were randomly divided into treatment group（n= 62）and control group（n = 62）. Patients in both two groups were given enteral nutrition（EN）plus parenteral nutrition（PN）after the hemodynamics became stable. In addition,patients in control group were given routine EN ＋ PN,while in treatment group was given decoction o four-drug juice ＋ EN plus glutamine ＋ PN. Prealbumin （PA）,serum total protein（ TP）,transferrin（ TF）and serum albumin（ ALB）were detected before and after treatment of nutritional support. The informations including recovery of bowel sounds,the occurrence of complications,antibiotic use time and the duration of ICU stay were recorded. Results There were no significant differences between two groups in terms of nutrition indices before treatment（P 〉 0. 05）. After treatment,the contents of pre albumin,transferrin,total serum protein,serum albumin in treatment group were（ 145. 24 ± 6. 72）g/ L,（1. 93 ± 0. 98）g/ L,（79. 86 ± 10. 38）g/ L,（54. 91 ± 2. 91）g/ L respectively,better than those in control groups（（139. 24 ± 38. 76）,（1. 68 ± 0. 33）,（74. 73 ± 7. 31）,（49. 87 ± 2. 61）g/ L）,and the differences were statistically significant（ t = 3. 610,2. 929,4. 360,6. 767;P 〈 0. 05）. The incidence of stress ulcer and double infection in treatment group were 42%（26 / 62）,37%（23 / 62）,significantly lower than the control group（59%（37 / 62）,53%（33 / 62））,and the differences were statistically significant（ χ2 = 5. 186, 5. 271,P 〈 0. 05）. Antibiotic use time and the duration of ICU stay in treatment group were（8. 82 ± 0. 71）d and（16. 14 ± 3. 01）d,and reaching full eternal nutrition time was（6. 90 ± 1. 01）d,decreased less than that in control group（（10. 21 ± 1. 30）,（20. 67 ± 2. 29）,（13. 91 ± 1. 51）d）and the differences were statistically significant（t = 8. 892,7. 786,3. 609,P 〈 0. 05）. The average recovery time of bowel sounds and first anal exhaust time average in treatment group were（26. 8 ± 3. 6）h,（25. 4 ± 3. 2）h,lower than that in control group （（38. 4 ± 4. 8）h,（37. 6 ± 4. 9）h）and the differences were statistically significant（ t = 3. 551,2. 516,P〈 0. 05）. Conclusion The application of decoction of four-drug juice plus glutamine on nutritional support of the elderly critically ill patients can reduce complications,shorten the duration of ICU,recover the intestinal function as soon as possible. Meanwhile,patients can transit to full eternal nutrition as soon as possible,then the cost of therapy is reduced and rehabilitation is quickly.