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目的探讨早期低剂量肠内营养联合谷氨酰胺支持治疗重症颅脑损伤患者的机制。方法将200例急性重症颅脑损伤患者随机分为观察组(早期低剂量肠内营养+谷氨酰胺支持治疗组)和对照组(早期低剂量肠内营养组)各100例,均于起病后48h给予肠内营养支持治疗。分别于治疗前及治疗后第7天抽取静脉血,检测血清炎性反应指标:C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-a(TNF-α)水平的变化及反应肠道黏膜屏障功能指标:血清二胺氧化酶(DAO)水平、肠脂肪酸结合蛋白(IFABP)、尿乳果糖/甘露醇(L/M)水平的变化,比较治疗后7天生化指标及临床效果。结果治疗前2组CRP、IL-6、TNF-α水平差异无统计学意义(P>0.05);治疗后第7天,2组血清CRP、IL-6、TNF-α水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前2组DAO、IFABP、L/M水平差异均无统计学意义(P>0.05);治疗后第7天,2组患者IFABP、L/M水平低于治疗前,DAO水平高于治疗前,且观察组优于对照组,差异均有统计学意义(P<0.05)。治疗后第7天观察组谷草转氨酶、血清肌酐、ICU住院费用低于对照组,ICU住院时间短于对照组,差异均有统计学意义(P<0.05),2组VAP发生率差异无统计学意义(P>0.05)。结论早期低剂量肠内营养联合谷氨酰胺治疗可下调急性炎性反应,减少各脏器炎性打击,保护肠道黏膜屏障功能,有助于患者临床结局的良好转归。
Objective To explore the mechanism of early low-dose enteral nutrition combined with glutamine support in patients with severe craniocerebral injury. Methods A total of 200 acute severe craniocerebral injury patients were randomly divided into observation group (early low-dose enteral nutrition + glutamine support group) and control group (early low-dose enteral nutrition group) After 48h give enteral nutrition support treatment. Venous blood was taken before treatment and on the 7th day after the treatment, respectively. Serum inflammatory response indexes (CRP, IL-6, TNF-α) (DAO), intestinal fibrinolytic activity (IFABP) and lactulose / mannitol (L / M) were measured. The biochemical indexes of intestinal mucosal barrier were compared between the two groups Indicators and clinical effects. Results There was no significant difference in CRP, IL-6 and TNF-α levels between the two groups before treatment (P> 0.05). On the 7th day after treatment, the levels of CRP, IL-6 and TNF- , And the observation group was lower than the control group, the difference was statistically significant (P <0.05). There was no significant difference in the levels of DAO, IFABP and L / M between the two groups before treatment (P> 0.05). On the 7th day after treatment, the levels of IFABP and L / M in two groups were lower than those before treatment, , And the observation group was superior to the control group, the differences were statistically significant (P <0.05). On the 7th day after treatment, aspartate aminotransferase, serum creatinine, ICU hospitalization costs were lower than those in the control group, ICU length of stay was shorter than the control group, the difference was statistically significant (P <0.05), no significant difference in VAP incidence between the two groups Significance (P> 0.05). Conclusion Early low-dose enteral nutrition combined with glutamine treatment can reduce the acute inflammatory response, reduce the organ inflammatory attack, protect the intestinal mucosal barrier function, and help patients with a favorable outcome of clinical outcomes.