Soguel Ludivine, Chioléro René L, Ruffieux Christiane, Berger Mette M
Department of Intensive Care Medicine & Burns Centre, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Nutrition. 2008 Nov-Dec;24(11-12):1123-32. doi: 10.1016/j.nut.2008.05.024. Epub 2008 Aug 9.
Enteral glutamine supplementation and antioxidants have been shown to be beneficial in some categories of critically ill patients. This study investigated the impact on organ function and clinical outcome of an enteral solution enriched with glutamine and antioxidant micronutrients in patients with trauma and with burns.
This was a prospective study of a historical control group including critically ill, burned and major trauma patients (n = 86, 40 patients with burns and 46 with trauma, 43 in each group) on admission to an intensive care unit in a university hospital (matching for severity, age, and sex). The intervention aimed to deliver a 500-mL enteral solution containing 30 g of glutamine per day, selenium, zinc, and vitamin E (Gln-AOX) for a maximum of 10 d, in addition to control treatment consisting of enteral nutrition in all patients and intravenous trace elements in all burn patients.
Patients were comparable at baseline, except for more inhalation injuries in the burn-Gln-AOX group (P = 0.10) and greater neurologic impairment in the trauma-Gln-AOX group (P = 0.022). Intestinal tolerance was good. The full 500-mL dose was rarely delivered, resulting in a low mean glutamine daily dose (22 g for burn patients and 16 g for trauma patients). In burn patients intravenous trace element delivery was superior to the enteral dose. The evolution of the Sequential Organ Failure Assessment score and other outcome variables did not differ significantly between groups. C-reactive protein decreased faster in the Gln-AOX group.
The Gln-AOX supplement was well tolerated in critically ill, injured patients, but did not improve outcome significantly. The delivery of glutamine below the 0.5-g/kg recommended dose in association with high intravenous trace element substitution doses in burn patients are likely to have blunted the impact by not reaching an efficient treatment dose. Further trials testing higher doses of Gln are required.
肠内补充谷氨酰胺和抗氧化剂已被证明对某些类型的重症患者有益。本研究调查了富含谷氨酰胺和抗氧化微量营养素的肠内溶液对创伤和烧伤患者器官功能及临床结局的影响。
这是一项对历史对照组的前瞻性研究，纳入了一所大学医院重症监护病房收治的重症、烧伤和重大创伤患者（n = 86，40例烧伤患者和46例创伤患者，每组43例）（根据严重程度、年龄和性别匹配）。干预措施旨在除了所有患者的肠内营养以及所有烧伤患者的静脉微量元素治疗等对照治疗外，每天给予500毫升含30克谷氨酰胺、硒、锌和维生素E的肠内溶液（Gln-AOX），最长持续10天。
患者在基线时具有可比性，但烧伤-Gln-AOX组吸入性损伤更多（P = 0.10），创伤-Gln-AOX组神经功能损害更严重（P = 0.022）。肠道耐受性良好。很少能给予完整的500毫升剂量，导致谷氨酰胺日均剂量较低（烧伤患者为22克，创伤患者为16克）。在烧伤患者中，静脉微量元素给药优于肠内剂量。序贯器官衰竭评估评分及其他结局变量在各组之间无显著差异。Gln-AOX组C反应蛋白下降更快。
Gln-AOX补充剂在重症受伤患者中耐受性良好，但未显著改善结局。烧伤患者谷氨酰胺给药低于推荐的0.5克/千克剂量，同时静脉微量元素替代剂量较高，可能因未达到有效治疗剂量而削弱了其影响。需要进一步试验测试更高剂量的谷氨酰胺。
