腸道營養補充麩醯胺酸對外科加護病房患者血液麩醯胺酸濃度及臨床結果之影響

Effect of Enteral Glutamine Supply on Nutritional Status and Clinical Outcome of Patients in Surgical Intensive Care Unit

柯婉菁(Wang-Ching Ko)

指導教授 ： 王進崑

中山醫學大學/健康管理學院/營養學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00102

摘要

麩醯胺酸是人體含量最豐富的胺基酸，參與體內重要代謝反應，是人體腸黏膜細胞、免疫細胞等快速增生細胞的能量來源。研究指出，改善重症病人血漿中麩醯胺酸的濃度，能夠增加組織中穀胱甘肽的濃度、提升免疫功能、降低住院感染率及降低住院天數等。在台灣目前沒有加護病房(Intensive Care Unit, ICU)的重症患者血漿麩醯胺酸濃度及給予麩醯胺酸後治療結果的相關研究。
本研究採隨機、雙盲、安慰劑對照之實驗設計，共計14位受試者參與，實驗組根據受試者個別之營養狀況給予麩醯胺酸（由益富公司提供）0.3-0.5 g/kg/day，而對照組則給等克數的安慰劑（麥芽糊精）。依據受試者個別情況，補充7~14天。結果顯示，重症患者血漿麩醯胺酸濃度高於420 µmol/L時，住ICU天數有減少的趨勢。給予麩醯胺酸補充後，受試者血漿的麩醯胺酸濃度顯著增加，但兩組在熱量、蛋白質攝取量、血液生化值及發炎指標並沒有顯著差異。發炎指標IL-6濃度雖有減少趨勢，但未達統計顯著，然而IL-6與血漿麩醯胺酸濃度有負相關(r=-0.59，p=0.035)。另外，重症患者接受腸道營養補充麩醯胺酸後，可顯著減少呼吸器使用天數。

關鍵字

麩醯胺酸 ； 加護病房 ； 重症患者 ； 發炎指標 ； 腸道營養 ； 呼吸器

並列摘要

Glutamine (Gln) is the most abundant free amino acid in the body. It has a number of key functions in metabolism. The main purpose of glutamine iis fuel provision for rapidly dividing cells, such as immune cells and gut mucosa cells. In addition, improved plasma Gln concentrations may benefit patients with critical illnesses, improve GSH biosynthesis in tissues, balance nitrogen level, enhance immunal function, and decrease the incidence of hospital-acquired infection. The glutamine recipients had a trend to reduce in length of the ICU stay. At the same time, there is not any study about the effect of glutamine in critical illness patients in Taiwan. We designed a study to investigate the effects of glutamine on the nutritional status and disease outcomes of Taiwanese ICU patients.
This was a randomized, double-blind, controlled clinical trial. Energy requirement, enteral formulation (without glutamine), and feeding rate are based on clinicians’ or dieticians’ order. 0.3-0.5g/kg/day glutamine or maltodextrin (control) 7-14 days. Results showed that critical illness patients plasma Gln concentrations >420 µmol/L, had a trend to reduce in length of the ICU stay. Plasma Glu was higher in the Glu group by day 8. But illness severity indices, clinical demographics, enteral energy and protein intake and major biochemical indices were similar between groups during study. Interleukin although had a trend to decrease, not statistically significant. However, IL-6 negative correlation with the plasma Gln concentrations (r=-0.59, p=0.035). In conclusion, days on ventilator had a significant reduction in critical illness patients receiving enteral feeding with glutamine.

並列關鍵字

Glutamine ； Intensive Care Unit ； Critical illness patients ； Inflammatory marker ； Enteral formulation ； Ventilator

參考文獻

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