免疫調整配方對加護病房患者營養狀況及發炎反應指標之影響

Effects of Immune-modulating Formula on Nutritional Status and Inflammatory Marker in ICU Patients

賴聖如(Sen-Ju Lai) ； 林明燦(Ming-Tsan Lin) ； 趙安怡(Anne Chao) ； 葉松鈴(Sung-Ling Yeh)

《臺灣營養學會雜誌》 31卷3期 (2006/09) Pp. 95-101

https://doi.org/10.6691/NSJ.200609_31(3).0004

摘要

本研究探討免疫調節配方對重症患者是否可改善營養狀況並降低發炎指標。實驗對象為一般外科加護病房中的患者12名，其Acute Physiology and Chronic Health EvaluationⅡ(APACHⅡ)指數為8~15，隨機分成2組每組6名，均經由腸道灌食，實驗組給予兩種免疫調節配方之其中一種（Impact-glutamine或Nu-Immune），此二配方均為添加精胺酸、n-3脂肪酸、麩醱胺之均衡完整配方。對照組則給予一般之高蛋白配方。經灌食一星期後比較兩組間前白蛋白、白蛋白、C反應蛋白、白血球數、APACHⅡ及全身性發炎反應症候群(SIRS)指數之差異性。結果顯示在腸道營養介入前，兩組在年齡、身高、體重、熱量需求、平均攝取量、營養狀況指標、發炎反應指標及疾病嚴重度問均無差異。給予一星期的腸道營養補充後，兩組APACHⅡ指數明顯下降，前白蛋白及白蛋白則顯著上升。實驗組SIRS指數在腸道營養補充後下降，對照組則無差異。本研究結果顯示，中度重症患者，即早給予腸道營養可改善蛋白質營養狀況，並降低APACHⅡ指數。重症患者在使用免疫調節配方後，可降低SIRS指數，但使用免疫調節配方在改善營養狀況及發炎反應指標上與一般均衡配方並無差異。

關鍵字

加護病房患者 ； 免疫調節配方 ； 前白蛋白 ； 白蛋白 ； C反應蛋白

並列摘要

This study compared the effects of immune-modulating formula (Impact-glutamine or Nu-Immune) and complete balanced formula on the nutritional status and inflammatory markers in intensive care unit (ICU) patients. The immune-modulating formulas contain arginine、n-3 fatty acid and glutamine in addition to complete balanced nutrition. Twelve ICU patients with Acute Physiology and Chronic Health Evaluation Ⅱ (APACH Ⅱ) with score 8~15 were randomly assigned to the control and the test groups with enteral feeding for one week. The control group was fed with a general balanced formula, whereas the test group was fed with either Impact-glutamine or Nu-Immune. Blood samples were collected before and after the experimental period to compare the plasma pre-albumin, albumin, C-reactive protein levels, leukocyte counts, APACH Ⅱ score and systemic inflammatory response syndrome (SIRS) score between groups. The results showed that there were no differences in age, body weight, height, nutritional status and inflammatory markers between the 2 groups before nutritional intervention. However, affer enteral feeding for 7 days, APACH Ⅱ score reduced, While albumin and pre-albumin levels increased, regardless the patients were fed with immune-modulating or general formula. Patients with immune-modulating formula reduced the SIRS score after feeding for 7 days. These results suggest that enteral feeding improved protein status in ICU patients. Formula with specific nutrients supplementation reduced the severity of the diseases. Nevertheless, compared with the general balanced formula, immune-modulating diet had no favorable effects on nutritional status and inflammatory markers in critically ill patients.

並列關鍵字

ICU patients ； immune-modulating formula ； prealbumin ； albumin ； C-reactive protein