CAJ | 학술논문

目的：探讨视黄醇结合蛋白检测及谷氨酰胺应用在严重脓毒症患儿营养支持治疗中的价值。方法108例严重脓毒症患儿机体状况给予相应的营养支持，选择肠内营养（EN ）或肠外营养（PN），或同时给予EN和PN ，PN组分谷氨酰胺（Gln）组和非Gln组。对视黄醇结合蛋白（RBP）、血清白蛋白（ALB）、24 h尿尿素氮、小儿危重症评分（PCIS）、患儿多器官功能障碍（MODS）数目、机械通气时间、存活和死亡患儿的危重评分（PC IS ）及其器官受累数目，以及两组患儿的基础营养指标和代谢指标进行监测；并对存活患儿营养支持前0 d、营养支持第3天和第7天的血清RBP 、PA、ALB、Hb水平等进行比较。结果存活组患儿营养支持10 d内热卡明显高于死亡组。存活组患儿 PN时Gln组免疫球蛋白明显高于非Gln组，氮平衡状况也好于非Gln组。EN组与PN＋ EN组在治疗0 d、3 d时营养指标RBP、PA及氮平衡比较差异均有显著性（P＜0．05），而ALB、Hb差异无统计学意义（P＞0．05）。7 d后两组各项指标比较差异无显著性（P＞0．05）。死亡患儿的PCIS评分低于存活患儿，而器官受累数目多于存活组。存活儿与死亡患儿机体代谢状况及体液免疫指标比较差异有显著性（P＜0．05）。EN组患儿住PICU时间与机械通气时间较PN＋ EN组患儿短（P＜0．05）。结论严重脓毒症患儿机体表现为代谢率明显升高，能量消耗明显增加，蛋白分解利用大于合成，早期即出现血清RBP、PA水平的降低，呈现明显负氮平衡；病情越重，机体代谢指标、营养指标、免疫球蛋白水平等越低。对严重脓毒症患儿进行营养支持时加用Gln显得尤为重要。
목적：탐토시황순결합단백검측급곡안선알응용재엄중농독증환인영양지지치료중적개치。방법108례엄중농독증환인궤체상황급여상응적영양지지，선택장내영양（EN ）혹장외영양（PN），혹동시급여EN화PN ，PN조분곡안선알（Gln）조화비Gln조。대시황순결합단백（RBP）、혈청백단백（ALB）、24 h뇨뇨소담、소인위중증평분（PCIS）、환인다기관공능장애（MODS）수목、궤계통기시간、존활화사망환인적위중평분（PC IS ）급기기관수루수목，이급량조환인적기출영양지표화대사지표진행감측；병대존활환인영양지지전0 d、영양지지제3천화제7천적혈청RBP 、PA、ALB、Hb수평등진행비교。결과존활조환인영양지지10 d내열잡명현고우사망조。존활조환인 PN시Gln조면역구단백명현고우비Gln조，담평형상황야호우비Gln조。EN조여PN＋ EN조재치료0 d、3 d시영양지표RBP、PA급담평형비교차이균유현저성（P＜0．05），이ALB、Hb차이무통계학의의（P＞0．05）。7 d후량조각항지표비교차이무현저성（P＞0．05）。사망환인적PCIS평분저우존활환인，이기관수루수목다우존활조。존활인여사망환인궤체대사상황급체액면역지표비교차이유현저성（P＜0．05）。EN조환인주PICU시간여궤계통기시간교PN＋ EN조환인단（P＜0．05）。결론엄중농독증환인궤체표현위대사솔명현승고，능량소모명현증가，단백분해이용대우합성，조기즉출현혈청RBP、PA수평적강저，정현명현부담평형；병정월중，궤체대사지표、영양지표、면역구단백수평등월저。대엄중농독증환인진행영양지지시가용Gln현득우위중요。
Objective To explore the value of nutritional support with Retinol-binding protein as-say and use of Glutamine in Severe sepsis .Methods Total of 108 cases of children with severe sepsis given corresponding nutrition support according to the different condition and the body status ,to choose enteral nutrition (EN) or parenteral nutrition (PN) ,or given EN and PN at the same time .All patients were monitored by the standardized index ,and also were monitored the PCIS of the survival group and the dead group ,the numbers of involved organs ,nutrition indexes and metabolism indexes of the two groups ;compared the indexes such as serum prealbumin (PA ) ,retinal-binding protein (RBP) ,serum albumin (Alb) ,hemoglobin (Hb) ,etc ,of survived children before nutrition support 0d , with nutrition support 3d and 7d .Results Compared with the dead group ,the level of internal calories after 10d's nutrition support were significantly higher than in the survival group .Among the survival groups with parenteral nutrition ,compared with non-Gln group ,the level of immunoglobulin were sig-nificantly higher than in Gln group .After 0d and 3d's treatment ,there were statistically significant differences (P<0 .05) in the nutrition indexes such as serum prealbumin (PA) ,retinal-binding protein (RBP) and nitrogen balance between the EN group and EN+ PN group ,and the same time ,there were no statistically significant difference (P>0 .05) in the nutrition indexes ,such as serum albumin (Alb) and hemoglobin (Hb) .After 7d's treatment ,there were no significantly differences between the two groups(P>0 .05) .The dead group's PCIS were lower than the survival group's ,but numbers of in-volved organs were more .There were significantly differences of the body's metabolic state and humor-al immune parameters between the two groups .Compared with the EN+ PN group ,the time in PICU and time of mechanical ventilation were significantly shorter in the EN group (P<0 .05) .Conclusion The children with the more severe sepsis have the lower metabolic indexes ,nutrition indexes ,immuno-globulin ,etc .It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition ,and it is very important to choose EN or PN as individualized nutrition support treatment based on children's condition .