脓毒血症患者应用丙氨酰谷氨酰胺双肽强化早期肠内营养治疗的临床研究

发布时间：2018-03-11 02:32

  本文选题：脓毒血症　切入点：丙氨酰谷氨酰胺双肽强化　出处：《中国药房》2017年14期 　论文类型：期刊论文

【摘要】：目的:探讨脓毒血症患者早期应用丙氨酰谷氨酰胺双肽强化早期肠内营养(EN)支持治疗对其营养学指标、免疫指标、肝肾功能指标及并发症的影响。方法:选取我院2013年5月-2015年1月收治的112例脓毒血症患者,采用随机数字表法分为观察组和对照组,各56例。两组患者均接受常规抗菌治疗,同时进行早期(48 h)EN支持,每天氮补充量为0.2 g/kg,热量25 kcal/kg,非蛋白热量19~21 kcal/kg;观察组患者加用注射用丙氨酰谷氨酰胺0.5 g/kg加入0.9%氯化钠注射液100 mL中,24 h内持续泵人,疗程4 d。比较两组患者治疗前后营养学指标[血清白蛋白(ALB)、前白蛋白(PAB)、血红蛋白(Hb)],免疫指标[C反应蛋白(CRP)、免疫球蛋白(Ig)G、IgA、IgM]水平,急性生理与慢性健康(APACHEⅡ)评分,器官功能衰竭(SOFA)评分,以及肝肾功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血肌酐(Cr)、尿素氮(BUN)水平],并观察两组患者预后及并发症的发生情况。结果:治疗前,两组患者ALB、PAB、Hb、CRP、IgG、IgA、IgM、APACHEⅡ评分、SOFA评分、ALT、AST、Cr、BUN水平比较,差异均无统计学意义(P0.05)。治疗后,观察组患者ALB、PAB水平较治疗前显著升高,且观察组显著高于对照组,差异有统计学意义(P0.05);两组患者APACHEⅡ评分、SOFA评分较治疗前显著降低,且观察组显著低于对照组,差异均有统计学意义(P0.05);两组患者的CRP显著降低,Ig G显著升高,且观察组显著优于对照组,差异均有统计学意义(P0.05);两组患者的Cr、BUN水平较治疗前均显著降低,且观察组Cr水平显著低于对照组,差异均有统计学意义(P0.05)。观察组患者的重症监护病房停留时间、呼吸机使用时间、抗菌药物使用时间均显著短于对照组,腹泻和胃潴留发生率均显著低于对照组,差异均有统计学意义(P0.05)。结论:脓毒血症患者早期应用丙氨酰谷氨酰胺双肽强化的早期EN支持治疗能够显著改善患者免疫功能和肝肾功能,减少并发症的发生。
[Abstract]:Objective: to investigate the nutritional and immunological indexes of patients with sepsis treated with alanyl glutamine dipeptide (ALG) combined with early enteral nutrition (en). Methods: one hundred and twelve patients with sepsis were selected from May 2013 to January 2015 in our hospital. They were randomly divided into observation group and control group with 56 cases in each group. The patients in both groups were treated with routine antibacterial therapy. At the same time, the patients in the observation group were treated with early 48 h en support, the daily nitrogen supplementation was 0.2 g / kg, the calorie was 25 kcal / kg, the non-protein calorie was 1921 kcal / kg, and the patients in the observation group were continuously pumped with alanyl glutamine 0.5 g / kg for injection into 0.9% mL sodium chloride injection for 24 h, and the patients in the observation group were injected with alanyl glutamine 0.5 g / kg for 24 h. After 4 days of treatment, the levels of nutritional indexes [Alb, PABN, HB], immunological index [C-reactive protein CRPU, IgGG IgA- IgM], acute physiology and chronic health were compared between the two groups, and the scores of acute physiology and chronic health were compared. Organ failure score and liver and kidney function [alanine aminotransferase (alt), aspartate transaminase (AST), serum creatinine creatinine (Cr), urea nitrogen bun (bun)], and the prognosis and complications of the two groups were observed. There was no significant difference between the two groups in the level of ALB, PABX, HbP, IgG, IgA, IgMU, Apache 鈪，

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