含不同剂量谷氨酰胺肠内营养在老年危重患者营养支持中的应用

目的通过不同剂量谷氨酰胺肠内营养对老年危重患者的营养支持，观察老年危重患者营养状态、胃肠道功能改善情况。方法将90例老年危重患者完全随机化法分成3组：不含谷氨酰胺的营养支持对照组（A组），低剂量谷氨酰胺[0．3g/（kg·d）]肠内营养组（B组），高剂量谷氨酰胺[0．6g／（kg·d）]肠内营养组（C组）。于营养支持的第1、7、14天清晨采集空腹静脉血，测定血浆二胺氧化酶、谷氨酰胺，观察血清谷氨酰胺含量变化对肠黏膜屏障功能的影响，并测定血红蛋白、血清白蛋白、转铁蛋白、前白蛋白等营养指标及氮平衡情况，同时观察患者的腹胀、腹泻、胃潴留等胃肠道功能情况。结果营养支持后第7、14天B组和C组血浆谷氨酰胺水平分别为（1886．8±420．5）、（2228．6±440．2）g/L和（1889．6±436．1）、（2174．3±440．8）g/L，较A组（1612．0±493．5）和（1869．7±559．8）μg/L显著升高（P=0．027，P=0．008）；二胺氧化酶在B组和C组分别为（2310±1271）、（1602．5±1137．9）U／L和（2076．3±567）、（1586．3±530．9）U／L，较A组的（3250±923）和（2476±862）U／L显著降低（P=0．000，P=0．000）。营养支持后第7天转铁蛋白、前白蛋白明显改善（P=0．023，P=0．047），第14天血红蛋白明显改善（P=0．003）。B、C组成功实施EN人数和达到EN目标人数分别是4和25例、3和27例，较A组12和13例多（P=0．008，P=0．000），胃肠道的并发症发生率较A组少。结论含谷氨酰胺的肠内营养能早期改善危重患者的肠黏膜屏障功能和营养状态，减少胃肠功能并发症。通过肠道给予谷氨酰胺，有利于成功实施肠内营养，并实现全肠内营养。

Application of enteral nutrition support with different doses of glutamine in elderly critically ill patients

Objective To investigate the effects of enteral nutrition support with different doses of glutamine on nutritional status and gastrointestinal function in elderly critically ill patients. Methods Totally 90 critically ill patients were randomly divided into three group： the control group without glutamine （group A）, enteral nutrition with low glutamine [0. 3 g/（ kg · d） ] （ group B）, and high glutamine [0. 6 g/（ kg · d） ] groups （group C）. Fasting blood samples were collected on days 1,7, and 14 after the initiation of study, and then the indicators including serum diamine oxidase, glutamine, transferin （ TF）, prealbumin （ PA）, hemoglobin （HGB）, albumin, and nitrogen balance were determined. In addition, the gastrointestinal complications including bloating, diarrhea, and gastric retention were recorded. Results On the 7th and 14th days, the serum glutamine levels in groups B and C were （1 886.8 ± 420.5）, （2 228.6± 440. 2） μg/L;（1 889. 6 ±436. 1 ）, （2 174. 3 ± 440. 8） μg/L, respectively, which were significantly higher than those in group A [ （ 1 612.0 ±493.5 ） , （ 1 869. 7 ± 559. 8） μg/L] （ P = 0. 027, P = 0. 008 ）. The serum diamine oxidase levels were also significantly lower in group B [ （2 310 ±1 271 ）, （ 1 602. 5 ± 1 137.9） U/L] and group C [ （2076.3±567）, （1 586.3±530.9） U/L] thanin groupA [ （3250±923）, （2476±862） U/L] （P = 0.000, P = 0. 000 ）. The serum TF and PA levels were significantly increased on the 7th day （P = 0. 023, P = 0. 047 ）, and the HGB was significantly higher on 14th day （ P = 0. 003 ）, The number of patients who had undergone successful implementation of enteral nutrition were 4 and 3 in groups B and C, and the number of patients who had achieved the target volume of enteiTal nutrition was 25 and 27 in groups B and C, which were significantly larger than those in group A （ 12 and 13, respectively） （P =0. 008, P =0. 000）. The gastrointestinal complication was also significantly decreased after the administration of enterral nutrition with glutamine. Conclusions Enteral nutrition with glutamine can improve intestinal mueosa barrier and nutritional status in elderly critically ill patients. Thus, it helps to reduce gastrointestinal complications and transition time of total enteral nutrition.