發(fā)布時(shí)間：2018-03-11 02:32

  本文選題：膿毒血癥　切入點(diǎn)：丙氨酰谷氨酰胺雙肽強(qiáng)化　出處：《中國(guó)藥房》2017年14期 　論文類型：期刊論文

【摘要】：目的:探討膿毒血癥患者早期應(yīng)用丙氨酰谷氨酰胺雙肽強(qiáng)化早期腸內(nèi)營(yíng)養(yǎng)(EN)支持治療對(duì)其營(yíng)養(yǎng)學(xué)指標(biāo)、免疫指標(biāo)、肝腎功能指標(biāo)及并發(fā)癥的影響。方法:選取我院2013年5月-2015年1月收治的112例膿毒血癥患者,采用隨機(jī)數(shù)字表法分為觀察組和對(duì)照組,各56例。兩組患者均接受常規(guī)抗菌治療,同時(shí)進(jìn)行早期(48 h)EN支持,每天氮補(bǔ)充量為0.2 g/kg,熱量25 kcal/kg,非蛋白熱量19~21 kcal/kg;觀察組患者加用注射用丙氨酰谷氨酰胺0.5 g/kg加入0.9%氯化鈉注射液100 mL中,24 h內(nèi)持續(xù)泵人,療程4 d。比較兩組患者治療前后營(yíng)養(yǎng)學(xué)指標(biāo)[血清白蛋白(ALB)、前白蛋白(PAB)、血紅蛋白(Hb)],免疫指標(biāo)[C反應(yīng)蛋白(CRP)、免疫球蛋白(Ig)G、IgA、IgM]水平,急性生理與慢性健康(APACHEⅡ)評(píng)分,器官功能衰竭(SOFA)評(píng)分,以及肝腎功能[丙氨酸轉(zhuǎn)氨酶(ALT)、天冬氨酸轉(zhuǎn)氨酶(AST)、血肌酐(Cr)、尿素氮(BUN)水平],并觀察兩組患者預(yù)后及并發(fā)癥的發(fā)生情況。結(jié)果:治療前,兩組患者ALB、PAB、Hb、CRP、IgG、IgA、IgM、APACHEⅡ評(píng)分、SOFA評(píng)分、ALT、AST、Cr、BUN水平比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,觀察組患者ALB、PAB水平較治療前顯著升高,且觀察組顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者APACHEⅡ評(píng)分、SOFA評(píng)分較治療前顯著降低,且觀察組顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者的CRP顯著降低,Ig G顯著升高,且觀察組顯著優(yōu)于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者的Cr、BUN水平較治療前均顯著降低,且觀察組Cr水平顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組患者的重癥監(jiān)護(hù)病房停留時(shí)間、呼吸機(jī)使用時(shí)間、抗菌藥物使用時(shí)間均顯著短于對(duì)照組,腹瀉和胃潴留發(fā)生率均顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:膿毒血癥患者早期應(yīng)用丙氨酰谷氨酰胺雙肽強(qiáng)化的早期EN支持治療能夠顯著改善患者免疫功能和肝腎功能,減少并發(fā)癥的發(fā)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，

本文編號(hào)：1596220