Glutamine, Dietary Fibre Reinforcement Of Enteral Nutrition Support For Patients With Severe Trauma

Objective: Clinical study on the effects of glutamine and dietary fiber enhanced enteralnutrition in critically ill trauma patients on nutritional indicators, serum immune parameters andstress related indicators, in order to improve the nutritional status of critically ill patients,improve immunity, reduce stress reaction, prevent enterogenic infection, decrease the incidenceof complications and mortality rate, shorten the hospital days, improve prognosis and providescientific and feasible plan for the early enteral nutritional support of critically ill patients .Methods: 78 patients with severe trauma (cerebral hemorrhage coma, severe bone trauma)were randomly divided into test group and control group by random digits table. Both groupswere treated with routine enteral nutrition ( daily energy supply was calculated by a formula, theproportion of energy and nitrogen was 100 to 120: 1), the test group was added glutamine ( 0.5g /kg.d ) and soluble dietary fiber ( 3.0g / 1000kcal ) . Collected the fasting blood sample beforenutrition support and the eighth，fifteenth day early in the morning, then measured indicatorsincluding hemoglobin (HGB), serum total protein (TP), albumin (ALB), immunoglobulin (IgA,IgM, IgG) , T lymphocyte subsets ( CD4~+, CD8~+, CD4~+/ CD8~+), C-reactive protein (CRP) andfasting blood glucose (FBG), observed the gastrointestinal symptoms and whether hadintolerance.Results:1. Compared the control group ,HGB, TP, ALB levels were significantly higher in theeighth and fifteenth day in glutamine and dietary fiber enhanced enteral nutritional group (p<0.01).It indicated that the nutritional status of test group improved obviously than the controlgroup .2. CD4~+levels rised, the test group was significantly higher than the control group on thefifteenth day (p <0.05); Compared the control group Ig A, Ig G levels were significantly higheron the eighth，fifteenth day (p <0.01), Ig M levels were no statistical difference significance(p> 0.05). It indicated that glutamine and dietary fiber enhanced enteral nutrition could improvethe immune function.3 Before nutritional support, blood glucose levels of two groups were higher than normal,they decreased on the eighth, fifteenth day. Compared the control group ,FBG was statisticallydifferent (p<0.01), and the test group FBG was near normal levels on fifteenth day;CRPdecreased in both groups, and the test group decreased significantly (p <0.01). It indicated thatglutamine and dietary fiber enhanced enteral nutrition could improve the stress capability. 4 Two groups of patients on enteral nutrition were tolerated, no nausea, vomiting,gastrointestinal bleeding and adverse reaction, the incidence of constipation in the test group waslower than control group (p< 0.05 ), bloating, diarrhea and other clinical symptom significantlylighten, postprandial gastric retention amount was less. It indicated that after the intervention ofglutamine and dietary fiber, gastrointestinal function was good recovery .Conclusion:1 Glutamine and dietary fiber enhanced enteral nutrition can improve the nutritional statusof critically ill patients, retrieve negative nitrogen balance.2 Glutamine and dietary fiber enhanced enteral nutrition can improve immune function ofcritically ill patients, reduce the incidence of complications.3 Glutamine and dietary fiber enhanced enteral nutrition can reduce blood sugar, reduce therisk of high blood sugar and the stress response in critically ill patients.4 Glutamine and dietary fiber enhanced enteral nutrition can promote the gastrointestinalvermicular motion, improve the gastrointestinal function , mitigate excessus inflammatoryreaction and prevent enterogenic infection.