补充谷氨酰胺二肽的肠外营养对降低外科重症患者医院感染的疗效
Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients.
作者信息
Estívariz Concepción F, Griffith Daniel P, Luo Menghua, Szeszycki Elaina E, Bazargan Niloofar, Dave Nisha, Daignault Nicole M, Bergman Glen F, McNally Therese, Battey Cindy H, Furr Celeste E, Hao Li, Ramsay James G, Accardi Carolyn R, Cotsonis George A, Jones Dean P, Galloway John R, Ziegler Thomas R
机构信息
Emory University Hospital Nutrition and Metabolic Support Service, Department of Medicine, Atlanta, GA 30322, USA.
出版信息
JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):389-402. doi: 10.1177/0148607108317880. Epub 2008 Jun 9.
BACKGROUND
Nosocomial infections are an important cause of morbidity and mortality in the surgical intensive care unit (SICU). Clinical benefits of glutamine-supplemented parenteral nutrition may occur in hospitalized surgical patients, but efficacy data in different surgical subgroups are lacking. The objective was to determine whether glutamine-supplemented parenteral nutrition differentially affects nosocomial infection rates in selected subgroups of SICU patients.
METHODS
This was a double-blind, randomized, controlled study of alanyl-glutamine dipeptide-supplemented parenteral nutrition in SICU patients requiring parenteral nutrition and SICU care after surgery for pancreatic necrosis, cardiac, vascular, or colonic surgery. Subjects (n = 59) received isocaloric/isonitrogenous parenteral nutrition, providing 1.5 g/kg/d standard glutamine-free amino acids (STD-PN) or 1.0 g/kg/d standard amino acids + 0.5 g/kg/d glutamine dipeptide (GLN-PN). Enteral feedings were advanced as tolerated. Nosocomial infections were determined until hospital discharge.
RESULTS
Baseline clinical/metabolic data were similar between groups. Plasma glutamine concentrations were low in all groups and were increased by GLN-PN. GLN-PN did not alter infection rates after pancreatic necrosis surgery (17 STD-PN and 15 GLN-PN patients). In nonpancreatic surgery patients (12 STD-PN and 15 GLN-PN), GLN-PN was associated with significantly decreased total nosocomial infections (STD-PN 36 vs GLN-PN 13, P < .030), bloodstream infections (7 vs 0, P < .01), pneumonias (16 vs 6, P < .05), and infections attributed to Staphylococcus aureus (P < .01), fungi, and enteric Gram-negative bacteria (each P < .05).
CONCLUSIONS
Glutamine dipeptide-supplemented parenteral nutrition did not alter infection rates following pancreatic necrosis surgery but significantly decreased infections in SICU patients after cardiac, vascular, and colonic surgery.
背景
医院感染是外科重症监护病房（SICU）发病和死亡的重要原因。补充谷氨酰胺的肠外营养对住院手术患者可能具有临床益处，但不同手术亚组的疗效数据尚缺乏。目的是确定补充谷氨酰胺的肠外营养是否对SICU患者的特定亚组医院感染率有不同影响。
方法
这是一项双盲、随机、对照研究，研究对象为因胰腺坏死、心脏、血管或结肠手术而需要肠外营养和SICU护理的SICU患者，给予丙氨酰谷氨酰胺二肽补充的肠外营养。受试者（n = 59）接受等热量/等氮量的肠外营养，提供1.5 g/kg/d的标准无谷氨酰胺氨基酸（STD-PN）或1.0 g/kg/d的标准氨基酸 + 0.5 g/kg/d的谷氨酰胺二肽（GLN-PN）。根据耐受情况逐渐增加肠内喂养。确定直至出院的医院感染情况。
结果
两组间基线临床/代谢数据相似。所有组的血浆谷氨酰胺浓度均较低，GLN-PN使其升高。GLN-PN未改变胰腺坏死手术后的感染率（17例STD-PN患者和15例GLN-PN患者）。在非胰腺手术患者中（12例STD-PN患者和15例GLN-PN患者），GLN-PN与总医院感染显著降低相关（STD-PN组36例 vs GLN-PN组13例，P < .030）、血流感染（7例 vs 0例，P < .01）、肺炎（16例 vs 6例，P < .05）以及由金黄色葡萄球菌引起的感染（P < .01）、真菌和肠道革兰氏阴性菌引起的感染（均P < .05）。
结论
补充谷氨酰胺二肽的肠外营养未改变胰腺坏死手术后的感染率，但显著降低了心脏、血管和结肠手术后SICU患者的感染率。
Zotero 插件