The Role Of Glutamine In The Nutritional Support Of Critical Stroke Patients

Background and Object Patients with critical stroke are prone to malnutrition which is an independent risk factor for prognosis.Glutamine is the most abundant free amino acid in the body and has many physiological functions.This study aimed to investigate the role of GLN in enteral nutrition support in critical stroke through a randomized controlled trial.Method From June 2016 to December 2017,patients admitted to the Department of Neurology Intensive Care Unit(NICU)of the First Hospital of Jilin University who met the criteria for critical stroke were randomly divided into GLN group and control group.The enrolled patients were given special care,active treatment of primary disease and complications,and were given enteral nutrition support of isonitrogen and isocaloric within 48 hours after admission.On the basis of this,the GLN group was given glutamine granules 30g/d×7d via a nasogastric tube.Serum markers(blood GLN,oxidative stress indicators,intestinal barrier markers,immune function markers,nutritional status)and severity scores were collected before treatment and on the 7th day of treatment.At the time of discharge,the prognostic indicators such as length of hospital stay,total length of hospital stay,and antibiotic use were recorded.SPSS 17.0 software was used for statistical analysis to compare the pre-and post-treatment nutrition,infection,immunity and prognosis of the two groups of patients,and to analyze the effect of enteral GLN supplementation on patients with critical stroke.Results 1.There were 75 patients(53 males and 22 females)who met the criteria and completed the monitoring,including 39 in the GLN group and 36 in the control group,with an average age of 62(32-96 years).No statistical difference was observed in age,gender,BMI,and disease composition between the GLN group and the control group.2.Before treatment,the mean serum GLN in the GLN group and control group was 0.38 mmol/L,which was lower than the normal value.There was no significant difference between the two groups.On the 7th day,the serum GLN level increased in the GLN group(0.409±0.086)and decreased in the control group(0.367±0.105).The GLN group was higher than the control group,and the difference was statistically significant(p<0.05).3.Before treatment,according to different indicators to determine 4.2% to 32% of patients with malnutrition,after active enteral nutrition support,the incidence of malnutrition in the control group increased significantly,the GLN group did not change significantly.After treatment,RBP and LY in the GLN group and the control group increased,and the improvement in the GLN group was better than that in the control group(P<0.05).4.The average ratio of white blood cells and neutrophils before treatment was higher than normal,and the proportion of blood neutrophil was decreased after treatment,but no statistical difference was observed between the two groups(P>0.05).There was no significant difference in the proportions of normal,slightly elevated,and significantly elevated CRP between the two groups before and after treatment.The average duration of antibiotic application in both groups was 12 days.5.No significant difference was showed in MDA,SOD,DAO and GSH between the two groups and before and after treatment in each group(P>0.05).6.The NICU length of stay in the two groups was 12 days and 11 days respectively.The total length of hospital stay was 19 days and 17 days(P>0.05).Conclusion 1.Serum GLN in patients with critical stroke is lower than normal,and the addition of exogenous GLN by enteral nutrition can increase the content of the substance in the serum,and 30g/d is safe and effective.2.The incidence of malnutrition in patients with critical stroke is high,and malnutrition occurs despite active enteral nutrition support.The addition of exogenous GLN via the enteral method can improve the nutritional status of critical stroke patients more than that of the conventional nutrition group.3.Intra-individual addition of GLN did not show efficacy in the control of infection,oxidative stress,gut barrier function,immune function,and length of hospital stay in patients with critical stroke.