谷氨酰胺双肽强化的肠外营养对腹部手术患者谷胱甘肽水平的影响

Effects on glutathione of patients received glutamine dipeptide enriched parenteral nutrition post abdominal surgery

目的探讨谷氨酰胺双肽强化的肠外营养对腹部手术患者术后谷胱甘肽水平、免疫功能、肝功能及术后感染发生率、住院天数的影响。方法选择腹部外科手术患者40例,随机分为研究组与对照组,围手术期予完全肠外营养支持(TPN)7 d。对照组给予TPN,研究组给予TPN+谷氨酰胺双肽。两组均等氮、等热量,非蛋白热量83.6 kJ.kg-1.d-1,糖∶脂为7∶5,氮量0.16 g.kg-1.d-1,热、氮比489 kJ∶1 g。分别于术前、术后第1天,第3天及术后第6天采取血样测定血浆、红细胞氧化型谷胱甘肽(GSSG)及还原型谷胱甘肽(GSH)水平、血生化指标和免疫指标。结果研究组术后血浆及红细胞内谷胱甘肽下降程度小于对照组。血浆GSSG和GSH比值(术后第3天)研究组明显高于对照组(分别为53±11和31±7,F=4.725,P=0.001)。两组血浆白蛋白(ALB)术后均轻度下降,研究组术后第3天ALB水平明显高于对照组[分别为(3.8±0.4)g/d l和(3.4±0.4)g/d l,F=2.128,P=0.02]。术后两组免疫球蛋白(IgG、IgM、IgA),T淋巴细胞亚群(CD4,CD8及CD4/CD8)指标差异无统计学意义。研究组术后无感染发生,对照组术后1例发生切口感染。研究组患者住院天数较对照组有缩短趋势[分别为(22.3±2.1)d和(24.9±1.7)d,t=0.935,P=0.32)。结论围手术期应用谷氨酰胺双肽强化的肠外营养具有维持机体血浆及红细胞内谷胱甘肽水平的趋势,维持较高的GSH/GSSG比值,维护机体组织细胞抗氧化能力;维持术后ALB水平,对肝功能有一定保护作用;具有减少术后并发症,缩短住院天数的趋势。

Objective To observe the effects of glutamine （GLN） enriched parenteral nutrition （PN） on glutathione level, immune function, liver function, infectious complication and hospital stay of patients undergone abdominal operation. Methods Forty patients with abdominal surgical disease undergoing elective surgical treatment were randomly divided into two groups （study and control group）. All patients received total parenteral nutrition （TPN） for up to 7 days perioperatively. The control group received TPN while the study group received TPN including GLN dipeptide. Both groups received isonitrogen and isocaloric nutrition. Nonprotein caloric intake is 83.6 kJ · kg^-1 · day^-1, glycogen： lipid ratio is 7：5, nitrogen intake is 0. 16 g · kg^-1 · d^-1 , calories：nitrogen ratio is 489 kJ： 1 g. Results The decreasing degree of glutathione levels of plasma and red blood cell in study group is lower than that in control group postoperatively. GSH/GSSG ratio of plasma in study group is higher than that in control group on 3rd day postoperatively（53 ± 11 vs 31±7, F=4.725, P =0.001）. Albumin （ALB） of both groups decreased slightly postoperatively. ALB level of study group was higher than that of control group on 3rd day postoperatively[（3.8±0.4） g·dl^-1 vs （3.4±0.4） g·dl^-1, F=2.128, P=0.02]. No significant differences were noted between immunoglobin （ IgG, IgM and IgA ） and T lymphocyte subgroup （ CIM, CDS, CD4/CD8 ） levels of both groups postoperatively. There was no infectious complication in study group, while one in control group. There was shorten trend of hospital stay in study group compared with control group[ （22. 3 ± 2. 1 ） d vs （24. 9 ± 1.7） d, t = - 0. 935, P = 0. 32 ]. Conclusions Glutamine enriched PN has the trend of maintaining glutathione level of plasma and red blood cell in patients having undergone abdominal operation, and can sustain GSH/GSSG ratio and ALB level, protect antioxidant ability, promote liver function postoperatively. Glutamine enriched PN has the trend of shortening hospital stay, decreasing incidence of infectious complication.