摘要目的 探讨添加谷氨酰胺的肠内营养对急性期重型创伤性脑损伤(sTBI)患者消化道并发症、肠黏膜屏障功能、炎症反应及预后的影响. 方法 采用前瞻性随机对照研究分析2016年1月-2017年6月收治的107例sTBI患者临床资料.按随机数字表法分为对照组(未添加谷氨酰胺肠内营养组,53例)和试验组(添加谷氨酰胺肠内营养组,54例).记录患者一般资料.比较两组治疗后消化道并发症.酶学分光光度计法测定肠黏膜屏障功能指标血清二胺氧化酶(DAO)、血清肠型脂肪酸结合蛋白(I-FABP)和D-乳酸血清浓度;双抗体夹心酶联免疫吸附测定法(ELISA)试剂盒检测炎症反应指标C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)血清浓度.比较两组格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分和住院时间. 结果 两组在性别、年龄、致伤原因、体重指数、GCS、APACHEⅡ评分、伤型和受伤至手术时间等方面,差异无统计学意义(P＞0.05).治疗后14d,试验组应激性溃疡、胃潴留、腹泻的发生率明显低于对照组(P＜0.05).治疗后14 d内,与对照组比较,试验组治疗后7,14 d血清DAO、D-乳酸和I-FABP,CRP、TNF-α和IL-6表达均明显降低(P＜0.05).试验组治疗后14 d GCS[(9.3±0.7)分]和APACHEⅡ评分[(15.3±1.1)分]较对照组[分别为(8.2±0.7)分、(17.7±1.2)分]改善(P＜0.05),住院时间[(19.1±2.2)d]短于对照组[(25.3±2.4)d](P＜0.01). 结论 对于急性期sTBI患者,添加谷氨酰胺的肠内营养能有效降低消化道并发症发生率,改善肠黏膜屏障功能,抑制炎症反应,进而改善患者病情及预后.

abstractsObjective To investigate the effects of enteral nutrition added with glutamine on the incidences of gastrointestinal complications,intestinal mucosal barrier function and inflammatory responses in patients with acute severe traumatic brain injury (sTBI).Methods A prospective case control study was made on 107 patients with sTBI hospitalized from January 2016 to June 2017.The patients were divided into experimental group added with glutamine (n =54) and control group without glutamine (n =53) according to the random number table.The general data of the patients were recorded.After treatment,the incidences of gastrointestinal complications in both groups were compared.The serum levels of intestinal mucosal barrier function indices,namely,diamine oxidase (DAO),Dlactate acid,and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method.Meanwhile,the serum levels of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α),and interleukin-6 (IL-6) were also tested with enzyme-linked immunosorbent assay (ELISA).Glasgow coma scale (GCS),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),and hospital stay in both groups were compared.Results The two group were comparable with respect to gender,age,injury reasons,body mass index,preoperative GCS,preoperative APACHE Ⅱ,injury type and injury time (P ＞ 0.05).The experimental group had lower incidences of stress ulcer,gastric retention and diarrhea compared with the control group 14 days after treatment (P ＜ 0.05).Within 14 days after treatment,the serum levels of DAO,D-lactate acid and I-FABP were significantly decreased in the experimental group at days 7 and 14 after treatment (P ＜ 0.05).The serum levels of CRP,TNF-α and IL-6 in the experimental group were significantly decreased after treatment (P ＜ 0.05).The experimental group had better prognosis compared with the control group (P ＜ 0.05),with higher GCS scores [(9.3 ± 0.7) points vs.(8.2 ± 0.7) points],lower APACHE Ⅱ scores [(15.3 ± 1.1) points vs.(17.7 ± 1.2) points] at day 14,and shorter hospital stay [(19.1 ± 2.2) days vs.(25.3 ± 2.4) days] (P ＜ 0.01).Conclusions Enteral nutrition added with glutamine can effectively reduce the incidence of gastrointestinal complications,as well as alleviate the intestinal mucosal barrier function damage and the inflammatory responses at early stage after sTBI,which possibly improves prognosis.