强化谷氨酰胺营养支持对老年危重症患者肠屏障功能及免疫功能的影响
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摘要
目的探讨强化谷氨酰胺营养支持对老年危重症患者肠屏障功能及免疫功能的影响。方法回顾性分析2015年3月至2018年2月遂宁市中心医院重症监护室收治的84例老年危重症患者的临床资料,按照治疗方法分为观察组和对照组,每组各42例。对照组患者给予常规肠内营养支持,观察组患者在此基础上给予谷氨酰胺强化治疗,两组均治疗2周,比较两组患者治疗前后营养学指标变化、T淋巴细胞亚群水平、肠屏障功能指标变化,并记录两组患者营养支持后不良反应发生情况。结果观察组治疗后血白蛋白(ALB)(42.51±3.12 g/L)、前白蛋白(PA)(259.82±15.02 mg/L)、血红蛋白(Hb)(125.84±7.23 g/L)均高于对照组(P<0.05)。观察组治疗后CD3~+、CD4~+、CD4~+/CD8~+均高于对照组(P<0.05)。观察组患者治疗后血清二胺氧化酶(DAO)(0.95±0.08μmol/L)和尿乳果糖/甘露醇(L/M)(0.105±0.030)比值均低于对照组(P<0.05)。两组患者营养支持后不良反应发生率分别为14.3%(6/42)和19.0%(8/42),差异无统计学意义(P>0.05)。结论对老年危重症患者在肠内营养支持基础上辅以谷氨酰胺强化治疗,有助于进一步改善患者机体营养状况,并可改善机体免疫功能,提高肠黏膜屏障功能,且用药安全性较高。
Objective To explore the effects of enhanced Glutamine nutrition support on intestinal barrier function and immune function in elderly patients with critical illness. Methods The clinical data of 84 elderly critically ill patients admitted from March 2015 to February 2018 in the intensive care unit of Suining central hospital were analyzed. According to the treatment methods,the patients were divided into the observation group and the control group,with 42 cases in each group. The patients in the control group were given routine enteral nutrition support,and the patients in the observation group were treated with glutamine on this basis. The two groups were treated for 2 weeks. The changes of nutrition index,T lymphocyte subgroup and intestinal barrier function before and after treatment in the two groups were compared,and the adverse reactions were recorded in the two groups of patients after nutritional support. Results ALB,PA and Hb in the observation group were higher than those in the control group after treatment( P < 0. 05). After treatment,CD3~+,CD4~+ and CD4~+/CD8~+ in the observation group were higher than those in the control group( P < 0. 05). Serum DAO and urinary L/M ratio in the observation group after treatment were lower than those in the control group( P < 0. 05). The adverse reaction rates of the two groups after nutrition support were 14. 3%( 6/42) and 19. 0%( 8/42) respectively,and the comparison was not statistically significant( P > 0. 05). Conclusion The elderly critically ill patients in enteral nutrition support on the basis of intensive treatment with glutamine,helps to further improve the nutritional status,and can improve the body's immune function,improve the intestinal mucosal barrier function,and drug safety is higher.
Objective To explore the effects of enhanced Glutamine nutrition support on intestinal barrier function and immune function in elderly patients with critical illness. Methods The clinical data of 84 elderly critically ill patients admitted from March 2015 to February 2018 in the intensive care unit of Suining central hospital were analyzed. According to the treatment methods,the patients were divided into the observation group and the control group,with 42 cases in each group. The patients in the control group were given routine enteral nutrition support,and the patients in the observation group were treated with glutamine on this basis. The two groups were treated for 2 weeks. The changes of nutrition index,T lymphocyte subgroup and intestinal barrier function before and after treatment in the two groups were compared,and the adverse reactions were recorded in the two groups of patients after nutritional support. Results ALB,PA and Hb in the observation group were higher than those in the control group after treatment( P < 0. 05). After treatment,CD3~+,CD4~+ and CD4~+/CD8~+ in the observation group were higher than those in the control group( P < 0. 05). Serum DAO and urinary L/M ratio in the observation group after treatment were lower than those in the control group( P < 0. 05). The adverse reaction rates of the two groups after nutrition support were 14. 3%( 6/42) and 19. 0%( 8/42) respectively,and the comparison was not statistically significant( P > 0. 05). Conclusion The elderly critically ill patients in enteral nutrition support on the basis of intensive treatment with glutamine,helps to further improve the nutritional status,and can improve the body's immune function,improve the intestinal mucosal barrier function,and drug safety is higher.
引文
[1]黄华田,罗善高,韦定春.老年危重症患者的优化营养支持分析[J].现代医药卫生,2018,34(7):1058-1059.
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[5]周军,杨斌,张育超,等.老年结直肠癌腹腔镜根治术后早期肠内营养的快速康复价值分析[J].临床和实验医学杂志,2016,15(13):1253-1256.
[6]鱼晓波,阮征,黄海龙,等.食管癌术后早期肠内营养对肠黏膜屏障功能及免疫功能的影响[J].临床外科杂志,2013,21(1):39-42.
[7]林燕.谷氨酰胺保护肠屏障功能的机制与临床应用研究进展[J].国际儿科学杂志,2017,44(6):385-388.
[8]刘敏,张长城,顿耀艳.谷氨酰胺对肠道黏膜屏障功能保护作用的研究进展[J].广东医学,2016,37(22):3463-3465.
[9]赵永华,杨开敏,贾秀艳,等.丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶水平的影响[J].中国全科医学,2014,17(2):214-216.
[10]周燕.肠内应用谷氨酰胺对重症颅脑外伤患者免疫功能的作用分析[J].河南医学研究,2014,23(5):135-136.
[11]孙鹏,李双成.用谷氨酰胺强化早期肠内营养对ICU患者机体应激和免疫功能影响的研究[J].热带医学杂志,2013,13(10):1250-1252,1300.
[12]王海燕,曹婧然,谢颖,等.谷氨酰胺强化肠内营养对ICU患者氧化应激状态影响的临床研究[J].临床误诊误治,2013,26(9):97-99.
[2]周亚光,杨光田.营养风险筛查方法简介(NRS 2002)[J].内科急危重症杂志,2010,16(2):106,110.
[3]邵利梅,杨小云,丁进.危重症患者早期肠内营养与肠黏膜屏障的相关性研究进展[J].国际消化病杂志,2017,37(5):282-284,315.
[4]陈云端.老年患者腹部大手术后早期免疫肠内营养支持的疗效及肠黏膜屏障的保护作用[J].中国老年学杂志,2013,33(20):5188-5190.
[5]周军,杨斌,张育超,等.老年结直肠癌腹腔镜根治术后早期肠内营养的快速康复价值分析[J].临床和实验医学杂志,2016,15(13):1253-1256.
[6]鱼晓波,阮征,黄海龙,等.食管癌术后早期肠内营养对肠黏膜屏障功能及免疫功能的影响[J].临床外科杂志,2013,21(1):39-42.
[7]林燕.谷氨酰胺保护肠屏障功能的机制与临床应用研究进展[J].国际儿科学杂志,2017,44(6):385-388.
[8]刘敏,张长城,顿耀艳.谷氨酰胺对肠道黏膜屏障功能保护作用的研究进展[J].广东医学,2016,37(22):3463-3465.
[9]赵永华,杨开敏,贾秀艳,等.丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶水平的影响[J].中国全科医学,2014,17(2):214-216.
[10]周燕.肠内应用谷氨酰胺对重症颅脑外伤患者免疫功能的作用分析[J].河南医学研究,2014,23(5):135-136.
[11]孙鹏,李双成.用谷氨酰胺强化早期肠内营养对ICU患者机体应激和免疫功能影响的研究[J].热带医学杂志,2013,13(10):1250-1252,1300.
[12]王海燕,曹婧然,谢颖,等.谷氨酰胺强化肠内营养对ICU患者氧化应激状态影响的临床研究[J].临床误诊误治,2013,26(9):97-99.