정맥영양 투여 받는 60세 이상 중환자에서 glutamine 사용에 따른 임상 효과의 변화
Change of Clinical Effect upon Use of Glutamine to Critically Ill Patients over Age 60 Receiving TPN
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: It is known to reduce the mortality when glutamine is supplied to patients during the surgery or in intensivecare unit through intravenous nutrition supply. The purpose of this study is to establish the appropriate basis foruse of glutamine and guidelines of nutrition supply for critically ill patients in the hospital by examining the clinicaleffects of administration of glutamine with subjects of elderly critically ill patients receiving intravenous nutrition in onehospital in Korea. Method: Among elderly patients with age of 60 or more hospitalized in Yeuido St. Mary’s Hospitalfrom August 2012 to July 2013, those who stayed in the intensive care unit for more than a week and received TPN(Total Parenteral Nutrition) for more than 3 days during staying in the intensive care unit were classified to a test groupusing glutamine and a control group without glutamine. Duration of use of mechanical ventilator, duration of hospitalization,occurrence of infectious disease and death were compared between two groups. We would like to identify theclinical test figures affected by the use of glutamine by examining changes in SCr, Total Protein, Albumin, AST, ALT,TB, DB and GFR at the time of admission and discharge. Results: At the time of admission to intensive care unit,gender, physical measurement information and clinical test figures did not show any significant difference between 72subjects in a test group and 24 subjects in a control group. Thus, two groups began in the same condition. There wereno significant difference in duration of hospitalization, duration of intensive care unit, use of mechanical ventilator,occurrence of infectious disease and death. As the results of statistical analysis of the average changes of clinical testfigures at the time of admission and discharge of intensive care unit, SCr and GFR were significantly changed in thetest group. GFR was significantly changed in a control group. As the result of analysis of the clinical test figures at thetime of discharge with reflection of average changes after clinical test figures were corrected at the time of admissionof intensive care unit, TB and GFR were significantly increased in a test group compared with those in a control group. Other clinical test figures were not significantly changed. Conclusion: If glutamine is administered to critically illpatients over age 60 receiving TPN and careful monitoring for total bilirubin is made in the future, it is expected togive the positive effect on renal function andminimize the side effect of arise in total bilirubin.
Abstract
Background: It is known to reduce the mortality when glutamine is supplied to patients during the surgery or in intensivecare unit through intravenous nutrition supply. The purpose of this study is to establish the appropriate basis foruse of glutamine and guidelines of nutrition supply for critically ill patients in the hospital by examining the clinicaleffects of administration of glutamine with subjects of elderly critically ill patients receiving intravenous nutrition in onehospital in Korea. Method: Among elderly patients with age of 60 or more hospitalized in Yeuido St. Mary’s Hospitalfrom August 2012 to July 2013, those who stayed in the intensive care unit for more than a week and received TPN(Total Parenteral Nutrition) for more than 3 days during staying in the intensive care unit were classified to a test groupusing glutamine and a control group without glutamine. Duration of use of mechanical ventilator, duration of hospitalization,occurrence of infectious disease and death were compared between two groups. We would like to identify theclinical test figures affected by the use of glutamine by examining changes in SCr, Total Protein, Albumin, AST, ALT,TB, DB and GFR at the time of admission and discharge. Results: At the time of admission to intensive care unit,gender, physical measurement information and clinical test figures did not show any significant difference between 72subjects in a test group and 24 subjects in a control group. Thus, two groups began in the same condition. There wereno significant difference in duration of hospitalization, duration of intensive care unit, use of mechanical ventilator,occurrence of infectious disease and death. As the results of statistical analysis of the average changes of clinical testfigures at the time of admission and discharge of intensive care unit, SCr and GFR were significantly changed in thetest group. GFR was significantly changed in a control group. As the result of analysis of the clinical test figures at thetime of discharge with reflection of average changes after clinical test figures were corrected at the time of admissionof intensive care unit, TB and GFR were significantly increased in a test group compared with those in a control group. Other clinical test figures were not significantly changed. Conclusion: If glutamine is administered to critically illpatients over age 60 receiving TPN and careful monitoring for total bilirubin is made in the future, it is expected togive the positive effect on renal function andminimize the side effect of arise in total bilirubin.
참고문헌 (20)
- Kondrup J., "Ad Hoc ESPEN Working Group. Nutritional rsik screening(NRS 2002) : a new method based on an analysis of controlled clinical trials", Clin Nutr, 22(3), pp.321~336 (2003)
- Yen PK., "Medical nutrition therapy saves money", Geriatr Nurs, 17(6), pp.293~294 (1996)
- Weinsier RL., "Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization", Am J Clin Nutr, 32(2), pp.418~426 (1979)
- Kang JH., "The Outcomes of Critically Ill Patients after Following the Recommendations of the Nutritional Support Team", KJPEN, 3(1), pp.40~44 (2010)
- Gottschlich MM, "Nutritional Support Dietetics. Core curriculum. 2NDed" (1993), ASPEN
- Matarese LE, "Contemporary nutrition Support Practice. A clinical guide. 2NDed" (2003), Saunders
- Dock-Nascimento DB., "Evolution of nutritional therapy prescription in critically ill patients", Nutr Hosp, 20(5), pp.343~347 (2005)
- Qui Y., "Nutrition support with glutamine dipeptide in patients undergoing liver transplantation", Transplant Proc, 41(10), pp.4232~4237 (2009)
- Heyland DK., "Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guideline for nutrition support in mechanically ventilated, critically ill adult patients", J Parenter Enteral Nutr, 27(5), pp.355~373 (2003)
- Jiang JW., "Enteral supplementation with glycyl-glutamine improves intestinal barrier function after liver transplantation in rats", Hepatobiliary Pancreat Dis Int, 10(4), pp.380~385 (2011)
- Vanek VW., "Novel Nutrient Task Force, Parenteral Glutamine Workgroup; American Society for Parenteral and Enteral Nutrition(A. S. P. E. N)Board of Directors. A. S. P. E. N position paper : parenteral nutrition glutamine supplementation", Nutr Clin Pract, 26(4), pp.479~494 (2011)
- Jones NE., "Pharmaconutrition : a new emerging paradigm", Curr Opin Gastroenterol, 24(2), pp.190~197 (2008)
- Jang CH, "Evidence based nutrition therapy in ICU", 6th Congress of the Korean Society for parenteral and Enteral Nutrition 2007, pp.49~51 (2007)
- Behara AS., "Nutrition support in the critically ill : a physician survey", J Parenter Enteral Nutr, 32(2), pp.113~119 (2008)
- Zhang Y., "Glutamine-induced heat shock protein protects against renal ischaemia-reperfusion injury in rats", Nephrology, 14, pp.573~580 (2009)
- Fuller TF., "Glutamine donor pretreatment in rat kidney transplants with severe preservation reperfusion injury", J Surg Res, 140, pp.77~83 (2007)
- Hwang JK., "The early-stage renal protective effect on the rat's renal ischemic-reperfusive damages after ischemic pretreatment and glutamine administration", 석사, pp.2011
- Wagner WH., "Silberman H. Similar liver function abnormalities occur in patients receiving glucosebased and lipid based parenteral nutrition", Am J Gasreoenteral, 78, pp.199~202 (1983)
- Kim IH, "The Evaluation of Liver Function on Cancer Patients Depending on the Total Calorie of TPN", 석사, pp.2006