The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia_West China Medical Journal

Authors：

 QIWei , HUANGFei , SUNZhong-yan , SUNBao-di , SUNZhao-rui , LINJin-feng ,  NIEShi-nan

Department of Emergency, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu 210002, P. R. China;

Corresponding author：

NIEShi-nan, Email: shn_nie@sina.com

Keywords：

Glutamine; Enteral nutrition; Sepsis; Hypoproteinemia

DOI：

10.7507/1002-0179.20140308

Video：

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Objective To explore the clinical effects of exogenous glutamine on patients suffering from sepsis with hypoalbuminemia in emergency department. Methods Eighty-six patients with sepsis and hypoalbuminemia enrolled from January to November 2013 in the Emergency Department of our hospital were randomly divided into treatment group and control group. Forty-three patients in the control group were given conventional treatments, while the other 43 in the treatment group were treated with glutamine therapy based on the conventional treatments. The clinical efficacy of the two groups including inflammatory markers, albumin level, APACHEⅡ score and SAPSⅡ score, mortality, length of hospital stay were analyzed on day 7, 14, and 28 after being enrolled. A comprehensive analysis of the clinical effects in these two groups was performed. Results Eighty-six cases were enrolled in this study. The mortality on day 14 and 28 in the treatment group was significantly lower than that in the control group (P<0.05). Inflammatory markers (WBC count, CRP concentration, and PCT concentration) in patients of the treatment group were gradually decreased, whereas serum albumin levels were gradually increased compared with the control group (P<0.05). The cure rate of patients in the treatment group was significantly higher than that in the control group, while the average length of stay was shorter than the control group (P<0.05) on day 28. Conclusion Exogenous glutamine supplementation can improve patient cure rates and reduce hospital stays which has good clinical effects on patients with sepsis and hypoalbuminemia in emergency department.

Citation： QIWei, HUANGFei, SUNZhong-yan, SUNBao-di, SUNZhao-rui, LINJin-feng, NIEShi-nan. The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia. West China Medical Journal, 2014, 29(6): 1007-1010. doi: 10.7507/1002-0179.20140308 Copy

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18.	胡秀英, 许春芳, 王超, 等. 含谷氨酰胺的肠外营养对急性胰腺炎患者预后影响的Meta分析[J]. 现代生物医学进展, 2013, 13(22): 4302-430.

1. 马晓春, 孙旖旎. 危重症患者输注白蛋白的利与弊[J]. 中华内科杂志, 2012, 51(11): 845-847.
2. 胡志华, 陈勉, 陈伟. 谷氨酰胺强化的肠内营养对脓毒症患者免疫功能的影响[J]. 中国热带医学, 2012, 12(6): 722-724.
3. Cavalcante AA, Campelo MW, De Vasconcelos MP, et al. Enteral nutrition supplemented with l-glutamine in patients with systemic inflammatory response syndrome due to pulmonary infection[J]. Nutrition, 2012, 28(4): 397-402.
4. 王玉, 张泓. 静脉谷氨酰胺双肽强化的肠内营养对脓毒症患者临床指标的影响[J]. 安徽医科大学学报, 2012, 47(11): 1333-1336.
5. Brinson RR, Kolts BE. Diarrhea associated with severe hypoalbuminemia: a comparison of a peptide-based chemically defined diet and standard enteral alimentation[J]. Crit Care Med, 1988, 16(2): 130-136.
6. 徐芳. 肠内营养支持相关腹泻影响因素分析[J]. 中国现代医生, 2012, 50(16): 49-50.
7. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J]. Intensive Care Med, 2003, 29(4): 530-538.
8. 习丰产, 耿艳霞, 虞文魁, 等. 肠内营养对长期禁食危重症病人炎性反应和细胞免疫的影响[J]. 肠外与肠内营养, 2013, 20(4): 212-215.
9. Hohn A, Schroeder S, Gehrt A, et al. Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock[J]. BMC Infect Dis, 2013, 13(1): 158.
10. 景炳文, 林兆奋. 关于毛细血管渗漏综合征救治中有关问题的讨论[J]. 中国危重病急救医学, 2009, 21(12): 705, 后插4.
11. 范江花, 祝益民, 张新萍. 脓毒症患儿低蛋白血症与CRP及PCT的相关性[J]. 中国当代儿科杂志, 2010, 12(11): 870-873.
12. 任巧. 谷氨酰胺对脓毒症患者胃肠道黏膜的保护作用研究[J]. 临床医学, 2013, 33(9): 72-73.
13. 崔巍, 孙翠明, 刘沛. 谷氨酰胺对肠粘膜上皮细胞合成多聚免疫球蛋白受体的影响[J] 陕西医学杂志, 2011, 40(11):1452-1454.
14. Han T, Li XL, Cai DL, et al. Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis[J]. Eur Rev Med Pharmacol Sci, 2013, 17(11): 1529-1535.
15. 周济宏, 李幼生, 洪志坚, 等. 肿瘤坏死因子对谷氨酰胺促大鼠小肠蛋白质合成的影响及途径[J]. 医学研究生学报, 2013, 26(12): 1244-1249.
16. 李明泉, 舒磊, 王晓霞, 等. 谷氨酰胺强化治疗对危重症病人临床结局影响的系统性研究[J]. 肠外与肠内营养, 2014, 21(2): 101-105.
17. Cruzat VF, Bittencourt A, Scomazzon SP, et al. Oral free and dipeptide forms of glutamine supplementation attenuate oxidative stress and inflammation induced by endotoxemia[J]. Nutrition, 2014, 30(5): 602-611.
18. 胡秀英, 许春芳, 王超, 等. 含谷氨酰胺的肠外营养对急性胰腺炎患者预后影响的Meta分析[J]. 现代生物医学进展, 2013, 13(22): 4302-430.

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West China Medical Journal

The Clinical Effects of Exogenous Glutamine on Sepsis Patients with Hypoalbuminemia

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