谷氨酰胺对老年脓毒症患者的临床疗效观察

摘要

Objective To evaluate the effect of glutamine ( Gin ) on elderly patients with sepsis. Methods Forty elderly patients with sepsis were involved in a randomized controlled clinical trial, and were divided into Gin intensive nutritional support group and control group ( 20 cases in each group ). Both groups received standard total parenteranutrition ( TPN ), and the patients in the Gin group were received intravenous infusion of the Gin ( 100 ml/d ) for 7days. The Alb, PAB,immune and biochemical markers( IgG,CD4, CD8, CD4/CD8, CRP )and APACHE II were detected before nutrition treatment and 8th day after nutrition treatment. Results The anthropometry and biochemical markers such as PAB and blood serum Alb in Gin group were significantly increased( P <0. 05, P <0.01 ), Immune markers such as CD4,CD4/CD8, immune globulin IgG were significantly increased after 7 days treatment in Gin group( P < 0.05 ). The C reactive protein( CRP ) and APACHEII count were decreased after 7 days treatment in the Gin group( P <0. 05 orP <0. 01 ), and it was more obviously in the Gin group than control group( P <0. 05 ). Conclusion It demonstrated that the Gin provided energy and promote protein synthesis, also improved nutritional supporting and lymphocyte immune functions, and was benefit to the sepsis patient in the elderly patients.%目的 观察老年脓毒症患者使用谷氨酰胺(Gln)对其营养状况、免疫和急性炎性反应的影响.方法 40例老年脓毒症患者采用前瞻、随机、对照临床研究,随机分为Gln强化营养组(n=20)和对照组(n=20).2组使用等热能肠外营养.Gln组另给予Gln 100 ml静脉滴注,每天1次,连续7 d.比较2组治疗前第1天和治疗后第8天的血清白蛋白(Alb)、前白蛋白(PAB)、血清免疫球蛋白G(IgG)、T辅助淋巴细胞(CD4)、T辅助淋巴细胞(CD4)/抑制性淋巴细胞比值(CD4/CD8) 、C反应蛋白(CRP)和急性生理与慢性健康评分(APACHE II).结果 Gln组治疗后的血清Alb、PAB、IgG、CD4、CD4/CD8均较治疗前升高(P<0.05,P<0.01),对照组治疗前后差异无统计学意义(P>0.05),2组差异有统计学意义(P<0.05),而2组CRP水平及APACHE II评分均较治疗前显著下降(P<0.05,P<0.01),且GIn组较对照组下降显著(P<0.05).结论 将Gln应用于老年脓毒症患者的营养支持治疗,不仅能提供能量和促进蛋白质合成,同时可调节免疫功能,提高临床疗效,对老年脓毒症的预后起到积极作用.