乳清蛋白对急诊脓毒症合并低蛋白血症患者血清白蛋白及相关炎症因子的影响
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摘要
目的观察乳清蛋白肠内营养对急诊脓毒症合并低蛋白血症的临床疗效及对患者血清中蛋白质和炎症指标水平的影响。方法 92例急诊脓毒症合并低蛋白血症患者随机分为对照组和观察组,每组46例。对照组患者给予常规基础治疗,观察组患者在此基础上给予乳清蛋白肠内营养治疗,比较2组患者治疗第28天的临床疗效、血清蛋白质水平、炎症指标及不良反应。结果观察组患者治疗总有效率为82.61%,显著高于对照组的63.04%(P<0.05)。观察组患者白蛋白、前白蛋白、总蛋白治疗后显著高于对照组(P<0.05);观察组患者炎症指标D-二聚体、C反应蛋白水平、降钙素原表达水平显著低于对照组(P<0.05);治疗过程中未发生明显不良反应。结论乳清蛋白对急诊脓毒症合并低蛋白血症患者临床效果显著,能够显著抑制炎症反应,建议临床推广使用。
OBJECTIVE To evaluate the clinical efficacy of whey protein on patients suffering from sepsis combined with hypoalbuminemia in emergency department and its influence on protein and inflammatory cytokines in serum. METHODS Ninty-two patients with sepsis and hypoalbuminemia were randomly divided into control group and observation group, 46 cases in each group. Control group was treated with basic treatment. Patients in observation group were treated with whey protein by enteral nutrition additionally. The clinical efficacy, the levels of protein and inflammatory cytokines in serum and adverse reactions were compared between the two groups. RESULTS The effective rate in observation group was 82.61%, significantly higher than 63.04% in control group(P<0.05). After treatment, the levels of albumin(ALB), prealbumin(PA) and total protein(TP)in observation group were significantly higher than those in control group(P<0.05). Inflammatory markers of D-dimer(D-D),C-reactive protein(CRP) and proealcitonin(PCT) in patients of the observation group were gradually decreased compared with the control group(P<0.05). During treatment, it showed no significant adverse reactions. CONCLUSION Whey protein has obvious curative effect and inhibit inflammatory response on sepsis combined with hypoalbuminemia, and it is suggested to apply in clinic.
OBJECTIVE To evaluate the clinical efficacy of whey protein on patients suffering from sepsis combined with hypoalbuminemia in emergency department and its influence on protein and inflammatory cytokines in serum. METHODS Ninty-two patients with sepsis and hypoalbuminemia were randomly divided into control group and observation group, 46 cases in each group. Control group was treated with basic treatment. Patients in observation group were treated with whey protein by enteral nutrition additionally. The clinical efficacy, the levels of protein and inflammatory cytokines in serum and adverse reactions were compared between the two groups. RESULTS The effective rate in observation group was 82.61%, significantly higher than 63.04% in control group(P<0.05). After treatment, the levels of albumin(ALB), prealbumin(PA) and total protein(TP)in observation group were significantly higher than those in control group(P<0.05). Inflammatory markers of D-dimer(D-D),C-reactive protein(CRP) and proealcitonin(PCT) in patients of the observation group were gradually decreased compared with the control group(P<0.05). During treatment, it showed no significant adverse reactions. CONCLUSION Whey protein has obvious curative effect and inhibit inflammatory response on sepsis combined with hypoalbuminemia, and it is suggested to apply in clinic.
引文
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[9]孙萍,王东强,刘伟.脓毒症患者白细胞计数及血清降钙素原和C-反应蛋白的动态变化[J].中华危重病急救医学,2014,26(7):516-518.
[10]XI F C,GENG Y X,YU W K,et al.Effects of enteral nutrition on inflammation responses and cellular immune function in critically ill patients with long-term fasting[J].Parent Enteral Nutr(肠外与肠内营养),2013,20(4):212-215.
[11]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.
[12]FAN J H,ZHU Y M,ZHANG K P.Correlation of hypoproteinemia with C-reactive protein and procalcitonin in children with sepsis[J].Chin J Contemp Pediatrics(中国当代儿科杂志),2010,12(11):870-873.
[13]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.
[2]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.
[3]HU Z H,CHEN M,CHEN W.Effect of glutamine-fortified enteral nutritional on immune function of septic patients[J].China Trop Med(中国热带医学),2012,12(6):722-724.
[4]MOU Y,SONG T T,GONG X,et al.Nutrition research of whey protein preparations for the treatment of severe liver damage in children[J].Chin J Appl Clin Pediatric(中华实用儿科临床杂志),2016,31(7):515-517.
[5]DELLINGER R P,LEVY M M,RHODES A.Surviving Sepsis Campaign:International Guidelines for Management of Severe Sepsis and Septic Shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[6]MURPHY C H,HECTOR A J,PHILLIPS S M.Considerations for protein intake in managing weight loss in athletes[J].Eur J Sport Sci,2015,15(1):21-28.
[7]LUO Y S,LIU Y L,LI L.Evaluation value of blood lactic acid dynamic monitoring and APACHEⅡscore in prognosis of sepsis[J].Chongqing Med(重庆医学),2017,46(24):3351-3353.
[8]ZHAO X X,SU Y Y,WANG M.Evaluation of neurointensive care unit performance in China:predicting outcomes of simplified acute physiology scoreⅡor glasgow coma scale[J].Chin Med(Eng I),2013,126(6):1132-1137.
[9]孙萍,王东强,刘伟.脓毒症患者白细胞计数及血清降钙素原和C-反应蛋白的动态变化[J].中华危重病急救医学,2014,26(7):516-518.
[10]XI F C,GENG Y X,YU W K,et al.Effects of enteral nutrition on inflammation responses and cellular immune function in critically ill patients with long-term fasting[J].Parent Enteral Nutr(肠外与肠内营养),2013,20(4):212-215.
[11]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.
[12]FAN J H,ZHU Y M,ZHANG K P.Correlation of hypoproteinemia with C-reactive protein and procalcitonin in children with sepsis[J].Chin J Contemp Pediatrics(中国当代儿科杂志),2010,12(11):870-873.
[13]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.