重庆医学
重慶醫學
중경의학
Chongqing Medicine
2015年
25期
3511-3513
,共3页
王宏宇%王超%胡建红%彭曦
王宏宇%王超%鬍建紅%彭晞
왕굉우%왕초%호건홍%팽희
谷氨酰胺%重度烧伤%肠内营养%肠外营养%能量摄入
穀氨酰胺%重度燒傷%腸內營養%腸外營養%能量攝入
곡안선알%중도소상%장내영양%장외영양%능량섭입
glutamine%severe burns%enteral nutrition%parenteral nutrition%energy intake
目的：研究不同途径补充谷氨酰胺(Gln)对重症烧伤患者能量摄入和预后的影响。方法采用回顾性研究方法,从2010年10月至2014年4月该科入院患者中选择符合入选标准的66例为研究对象。将伤后第5天开始通过胃肠途径给予 Gln的患者纳入肠内补充 Gln 组(n=31)；伤后5 d 以后仍通过静脉给予 Gln 的患者纳入肠外补充 Gln 组(n=35)。观察患者伤后1、2、3、4周能量摄入总量及比例、能量摄入/热量消耗比值、血糖控制情况及胰岛素使用量以及脏器损伤指标(血肌酐、尿素氮、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、肌酸激酶同工酶、乳酸脱氢酶)、病死率、ICU 住院时间和总住院时间等指标。结果在伤后1个月内,肠内补充 Gln 组患者能量摄入高于肠外补充 Gln 组,且通过胃肠获得的能量明显高于肠外补充 Gln 组,此外,ICU 住院日明显低于肠外补充 Gln 组(P <0.05)。两组糖、脂肪、蛋白质等供能比例,血糖控制情况及胰岛素用量,脏器损伤指标,总住院时间及病死率差异均无统计学意义(P >0.05)。结论经胃肠途径补充谷氨酰胺可能更加有利于改善烧伤患者肠道功能,提高肠内营养的耐受程度,增加患者能量摄入,有利于改善患者预后。
目的：研究不同途徑補充穀氨酰胺(Gln)對重癥燒傷患者能量攝入和預後的影響。方法採用迴顧性研究方法,從2010年10月至2014年4月該科入院患者中選擇符閤入選標準的66例為研究對象。將傷後第5天開始通過胃腸途徑給予 Gln的患者納入腸內補充 Gln 組(n=31)；傷後5 d 以後仍通過靜脈給予 Gln 的患者納入腸外補充 Gln 組(n=35)。觀察患者傷後1、2、3、4週能量攝入總量及比例、能量攝入/熱量消耗比值、血糖控製情況及胰島素使用量以及髒器損傷指標(血肌酐、尿素氮、丙氨痠轉氨酶、天鼕氨痠轉氨酶、總膽紅素、肌痠激酶同工酶、乳痠脫氫酶)、病死率、ICU 住院時間和總住院時間等指標。結果在傷後1箇月內,腸內補充 Gln 組患者能量攝入高于腸外補充 Gln 組,且通過胃腸穫得的能量明顯高于腸外補充 Gln 組,此外,ICU 住院日明顯低于腸外補充 Gln 組(P <0.05)。兩組糖、脂肪、蛋白質等供能比例,血糖控製情況及胰島素用量,髒器損傷指標,總住院時間及病死率差異均無統計學意義(P >0.05)。結論經胃腸途徑補充穀氨酰胺可能更加有利于改善燒傷患者腸道功能,提高腸內營養的耐受程度,增加患者能量攝入,有利于改善患者預後。
목적：연구불동도경보충곡안선알(Gln)대중증소상환자능량섭입화예후적영향。방법채용회고성연구방법,종2010년10월지2014년4월해과입원환자중선택부합입선표준적66례위연구대상。장상후제5천개시통과위장도경급여 Gln적환자납입장내보충 Gln 조(n=31)；상후5 d 이후잉통과정맥급여 Gln 적환자납입장외보충 Gln 조(n=35)。관찰환자상후1、2、3、4주능량섭입총량급비례、능량섭입/열량소모비치、혈당공제정황급이도소사용량이급장기손상지표(혈기항、뇨소담、병안산전안매、천동안산전안매、총담홍소、기산격매동공매、유산탈경매)、병사솔、ICU 주원시간화총주원시간등지표。결과재상후1개월내,장내보충 Gln 조환자능량섭입고우장외보충 Gln 조,차통과위장획득적능량명현고우장외보충 Gln 조,차외,ICU 주원일명현저우장외보충 Gln 조(P <0.05)。량조당、지방、단백질등공능비례,혈당공제정황급이도소용량,장기손상지표,총주원시간급병사솔차이균무통계학의의(P >0.05)。결론경위장도경보충곡안선알가능경가유리우개선소상환자장도공능,제고장내영양적내수정도,증가환자능량섭입,유리우개선환자예후。
Objective To investigate the effect of glutamine on energy intake and prognosis of severe burn patients in differ-ent pathway.Methods Using retrospective study method,we brought the patients into our study from October 2010 to April 2014 in accordance with the inclusion criteria.Patients who were given the Gln before 5 days after injury through gastric bowel were brought into the EN group,others who were given the Gln after 5 days after the injury through vein were brought into PN groups. A total of 66 patients were included in this study,with 31 cases of EN group and 35 cases of PN group.Total energy intake,external and internal energy intake,nutrients heating,energy intake/energy consumption ratio,blood glucose control,insulin use and viscera damage(the blood urea nitrogen,creatinine,alanine aminotransferase,aspartate aminotransferase,total bilirubin,creatine kinase,lac-tate dehydrogenase),ICU days,hospital stays and mortality were observed in 1,2,3,4 weeks after injury.Results Within a month after the injury,the energy intake of patients in EN group were more than PN group,especially the energy from intestinal canal.Be-sides,the ICU days of patients in EN group were shorter than patients in PN group (all P <0.05).Other indicators of two groups of patients were no significant statistical difference(P >0.05).Conclusion Supplement of Gln may be more conducive to improve the intestinal function in patients with burns may be more conducive to improve the intestinal function in patients with burns,im-prove the degree of tolerance of enteral nutrition,increase energy intake and conducive to improving the prognosis of patients.
