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目的探讨不同含氮量的全胃肠外营养支持(TPN)在脓毒症的应用效果。方法选择2013年10月至2014年10月脓毒症患者40例,依据全胃肠外营养支持氮量分为低氮量组20例与高氮量组20例,检测并比较营养支持前后氮平衡、血气指标及血生化指标水平。结果高氮量组与低氮量组TPN后6天均较TPN前1天氮平衡情况明显改善,TPN后6 d的氮平衡指数高氮量组明显高于低氮量组,低氮量组动脉血氧分压(Pa O2)值较行TPN前1天明显升高,动脉血二氧化碳分压(Pa CO2)值则明显降低,差异均有统计学意义(P<0.05);TPN后6 d,高氮量组总胆红素(TB)、丙氨酸氨基转移酶(GPT)、天门冬氨酸氨基转移酶(GOT)值较行TPN前1天明显下降,低氮量组GPT、GOT值较行TPN前1天下降,差异均有统计学意义(P<0.05);高氮量TPN后6天较行TPN前1天GPT、GOT值降低幅度明显大于低氮量组,TPN后6天,高氮量组尿素氮(BUN)、肌酐(Cr)值较行TPN前1天明显上升,差异均有统计学意义(P<0.05)。结论高氮量营养支持更显著地改善负氮平衡,并可有效地缓解肝功能损伤,但对肺功能及肾功能无明显改善;低氮量营养支持可以明显改善肺功能和肝功能,对肾脏负担小,但扭转负氮平衡效果不及高氮量营养支持。
Objective To investigate the effect of total parenteral nutrition support (TPN) with different nitrogen content in sepsis. Methods From October 2013 to October 2014, 40 patients with sepsis were divided into two groups according to total parenteral nutrition support: 20 cases in low-nitrogen group and 20 cases in high-nitrogen group. The levels of nitrogen before and after nutrition support were measured and compared Balance, blood gas and blood biochemical indicators. Results After 6 days of TPN treatment, the nitrogen balance of the high-nitrogen and low-nitrogen groups significantly improved compared with that of the first day of TPN. The nitrogen balance index of the 6th day after TPN was significantly higher than that of the low-nitrogen and high-nitrogen groups PaO2 was significantly higher than that of the first day before TPN and PaCO2 was significantly decreased (P <0.05). On the 6th day after TPN , Total bilirubin (TB), alanine aminotransferase (GPT) and aspartate aminotransferase (GOT) in high-nitrogen group were significantly lower than those in the first day before TPN. GPT, GOT (P <0.05). After 6 days of high-nitrogen TPN, the decrease of GPT and GOT value on the 1st day before TPN was significantly greater than that of the low-nitrogen group, while the value of TPN after 6 The levels of BUN and Cr in the high-nitrogen group were significantly higher than those of the 1 day before TPN, the differences were statistically significant (P <0.05). Conclusion High nitrogen nutrition support can significantly improve negative nitrogen balance, and can effectively alleviate liver injury, but no significant improvement in lung function and renal function; low nitrogen nutrition support can significantly improve lung function and liver function, kidney The burden is small, but reverse the negative nitrogen balance less effective than high nitrogen nutrition support.