丙氨酰谷氨酰胺双肽全肠外营养在胃肠道肿瘤患者术后的应用

Application of total parenteral nutrition with alanyl-glutamine dipeptide in postoperative patients of gastrointestinal neoplasms

目的探讨丙氨酰谷氨酰胺（Gla—Gin）双肽全肠外营养（total parenteral nutrition，TPN）在胃肠道肿瘤患者术后的应用。方法64例胃肠道肿瘤患者术后分为常规TPN组（对照组）32例和TPN＋Gla—Gln组（实验组）32例，所有患者术后第1～7天等热量（96．0kJ·kg^-1·d^-1）、等氮（0．25g·kg^-1·d^-1）的肠外营养治疗，实验组另外添加0．5g·kg^-1·d^-1的Gla-Gin双肽。观察血清白蛋白、血清前蛋白、氮平衡变化，并检测手术前后外周血IgG、IgM、IgA、C3、C4的变化。结果①两组患者血清白蛋白、前白蛋白在术后第1天均有下降，与术前相比差异非常显著（P〈0．01），术后第8天时两组均有回升，但对照组回升较慢，两组比较有显著性差异（P〈0．05）。②两组患者术后第4天IgG、IgA、IgM值均低于术前，与术前相比两组均有非常显著的差异（P〈0．01），实验组术后第8天IgG、IgA、IgM明显回升并高于术前，与对照组比较有显著性差异（P〈0．05）。实验组术后第8天C3、C4值与对照组比较有显著性差异（P〈0．05）。③实验组术后第8天氮平衡明显优于对照组（P〈0．01）。结论丙氨酰谷氨酰胺双肽全肠外营养在胃肠道肿瘤手术患者中使用安全，有助于改善患者术后的营养状况，提高患者的免疫功能。

Objective To investigate the application of dipeptide in postoperative patients of gastrointestinal n gastrointestinal neoplasms were randomly divided into groups all received isocaloric （96.0 kJ · kg^- 1 · d^ - 1 ） eoplasms total parenteral nutrition with alanyl-glutamine . Methods Sixty-four postoperative patients of study group and control group. The patients in the two and isonitrogen （0.25 g · kg^ - 1· d^ - 1） parenteral nutrition from postoperative day 1 to day 7, and the study group received additional alanyl-glutamine. The serum lefels of albumin, pre-albumin, IgG, IgA, IgM, C3, CA were measured before operation and on postoperative day 1 and 8. Nitrogen balance was calculated on postoperative day 1,4 and 8. Results Compared with preoperation, the serum levels of albumin and pre-albumin were 0. 01 ）. Compared with those of preoperation, IgG, IgM IgA day 4 in two groups （P 〈0. 01 ）, and increased in the study both significantly decreased in two groups （P 〈 levels were decreased significantly on preoperative group on postoperative day 8 （P 〈 0. 05 ）. C3 and CA levels in the study group were increased more than those in the control group （ P 〈 0. 05 ） on postoperative day 8. Nitrogen balance in the study group was better than those in the control group （ P 〈 0. 05 ） on postoperative day 8. Corlclusion Alanyl-glutamine dipeptide is beneficial to postoperative patients of gastrointestinal neoplasms, and can improve their nutritional status, enhance their immune function.