谷氨酰胺双肽强化的早期肠内营养支持对脓毒症患者肠道免疫功能的影响

摘要

目的：分析谷氨酰胺双肽强化的早期肠内营养支持对脓毒症患者肠道免疫功能的影响。方法回顾性分析2012年3月~2014年3月在本院就诊并行早期肠内营养支持的脓毒症患者112例，按照随机数字表法分为两组，对照组56例给予标准肠内营养，观察组56例给予标准肠内营养同时加用谷氨酰胺双肽强化，比较两组患者治疗前后营养、免疫和病情评估指标，对比并发症发生情况及临床观察结果。结果经早期肠内营养支持治疗后，两组患者血清ALB、PAB、CRP、IgA、IgG、CD4+、CD4+/CD8+、WBC、LC水平和APACHE Ⅱ评分均较治疗前有所改善，且观察组患者治疗效果更为显著(P<0.05)，血清Hb和IgM水平未发生明显变化(P>0.05)；观察组患者腹泻和胃潴留症状发生率明显低于对照组，ICU停留时间、机械通气时间和抗生素使用时间均显著缩短(P<0.05)。结论谷氨酰胺双肽强化的早期肠内营养支持临床疗效确切，能够有效增强脓毒症患者的免疫功能。%Objective To analyze the influence of early enteral nutritional support by intensified glutamine dipeptide on intestinal immune function in patients with sepsis. Methods 112 patients with sepsis visited our hospital from March 2013 to March 2014 and accepted early enteral nutritional support were retrospectively analyzed.They were randomly divided into two groups.In the control group,56 patients were treated with standard enteral nutrition,while in the obser-vation group,56 patients were provided with glutamine dipeptide intensifying.Indexes of nutrition,immune and disease condition evaluation before and after treatment between two groups were compared.The occurrence of complication and clinical observation outcomes were also compared. Results After early enteral nutritional supported therapy,level of serum ALB,PAB,CRP,IgA,IgG,CD4+,CD4+/CD8+,WBC,LC and APACHE II score were improved,compared with that be-fore treatment.The therapeutic effect in observation group was more significant(P<0.05).There was no obvious change in the level of serum Hb or serum IgM (P>0.05).In observation group,incidence rate of diarrhea and gastric retention was significantly lower than that in control group respectively,ICU stay time,time of mechanical ventilation and time of using antibiotics was significantly shorter than that in control group respectively(P<0.05). Conclusion Early enteral nutritional support by intensified glutamine dipeptide obtains a definite clinical effect and can effectively enhance immune func-tion in sepsis patients.