谷氨酰胺低热能肠内营养在重型颅脑损伤病人的早期应用

目的 探讨重型颅脑损伤病人早期应用谷氨酰胺(Gln)强化的低热能肠内营养的可行性及其临床效果。方法 72例严重颅脑损伤患者随机分为研究组和对照组。研究组(n=36)于伤后72h内予Gln强化的低热能肠内营养。对照组(n=36)于伤后予低热能肠外营养,5d～7d后逐步过渡到肠内营养。观察营养支持期间并发症发生情况和血清总蛋白、白蛋白、前白蛋白和淋巴细胞总数(TLC)的变化,伤后1d、3d、5d、7d、10d测空腹血糖。结果研究组TLC经Gln强化的低热能肠内营养后,升高明显(P<0.01),与对照组比较,差异有显著性(P<0.05)。血糖控制好于对照组(P<0.05)。应激性溃疡发生率也低于对照组(P<0.05)。结论 严重颅脑损伤病人早期应用Gln强化的低热能肠内营养安全可行,临床效果优于肠外营养。

Early hypocaloric enteral nutrition enriched by glutamine in patients with severe cerebral injury

Objective To investigate the safety, feasibility and clinical effect of early use ofhypocaloric enteral nutrition enriched by glutamine in patients with severe cerebral injury. Methods72 cases were randomized into two groups. Study group(n=36) started hypocaloric enteral nutritionenriched by glutamine within 72 hours after cerebral injury. Control group(n=36) was given hypocaloricparenteral nutrition until gradually substituted by enteral nutrition 5 days later. Nutrition parameter,blood glucose and the incidence rate of complication were compared between two groups. Results Totallymphocyte count of study group increased significantly (p<0.01) and was higher than that of controlgroup (p<0.05). Blood glucose of study group was lower than that of control group on the 7th,10th day(p<0.05). The complication cases in study group were lower than that in control group, but significantdifference only existed in stress-induced ulcer (p<0.05).Conclusions Early use of hypocaloric enteralnutrition enriched by glutamine in patients with severe cerebral injury was safe, feasible and good forrecovery.