消化内科药物专栏
ZHOU Rui-xiang
ObjectiveTo evaluate the effect of early enteral nutrition(EN)supplemented with glutamine (Gln) in the patients with severe acute pancreatitis(SAP).MethodsSixty SAP patients were randomly divided into three groups：parenteral nutrition group(PN, n＝20), enteral nutrition group(EN, n＝20) and EN＋Gln group(n＝20). Blood samples were collected for analysis of albumin(ALB), prealbumin(PAB), transferrin(TF), CD3,CD4,CD8,Creactive protein(CRP),interleukin6(IL6),tumor necrosis factorα(TNF-α), glutamine, endotoxin(ET) before treatment, 5 and 10 days after nutrition treatment. The infection rate, death rate, operation switching rate, MODS rate, duration and cost of hospitalization were measured as well.Results ① The CD3,CD4,CD8 and CD4/CD8 levels were increased after treatment, and those in the EN＋Gln group were significantly higher than those in other groups after 10 days of treatment(all P<0.05).②The CRP, IL6 and TNF-α secretion decreased after treatment, specifically for those in the EN＋Gln group which were lower than the EN group 10 days after treatment(all P<0.05).③Glutamine level increased 10 days after treatment, Posttreatment glutamine level in the EN＋Gln group was significantly higher than that in all other groups (P<0.05).④Endotoxin levels elevated gradually in PN group while ET levels in both EN and EN＋Gln groups significantly decreased after treatment (P<0.05). Posttreatment LPS level was significantly lower in the EN＋Gln group compared with that in the EN group (P<0.05).⑤ The infection rate, MODS rate, duration and cost of hospitalization were significantly lower in the EN＋Gln group compared to other groups(all P<0.05).ConclusionFor patients with severe acute pancreatitis, EN combined with Gln is superior to EN alone in improving body nutritional metabolism and immunological function. The Glnfortified EN promots the recovery of digestive function, prevents translocation of bacterial and endotoxin, and reduces inflammatory responses.
