左旋精氨酸对严重腹腔感染患者肠屏障功能的影响

Effect of L-Argine on intestinal barrier function in patients with severe intra-abdominal infection

目的:探讨左旋精氨酸对严重腹腔感染患者肠屏障功能的影响。方法:将手术证实为严重腹腔感染的患者40例,随机分为常规治疗组(n=20)和精氨酸治疗组(n=20),精氨酸治疗组在常规治疗基础上添加左旋精氨酸0.3g/(kg·d)静脉滴注,连续5d。分别于术前及术后4d抽取两组静脉血检测血浆内毒素、血浆D-乳酸水平和血清C反应蛋白,同时观察两组患者的全身炎症反应综合征(SIRS)评分、术后并发症发生率、平均住院时间。结果:术后4d精氨酸治疗组较常规治疗组血浆内毒素[(0.27±0.11)EU/Lvs(0.39±0.13)EU/L]、血浆D-乳酸水平[(2.47±0.57)!g/Lvs(3.87±0.98)!g/L)]、C反应蛋白水平[(23.12±16.33)mg/Lvs(39.30±17.45)mg/L)]、SIRS评分(0.76±0.89vs1.41±0.94)均显著减轻(P<0.05);术后并发症、平均住院时间两组差异无显著性。结论:左旋精氨酸可减轻严重腹腔感染患者全身炎症反应,维护肠屏障功能。

Objective To explore the effect of L-arginine on intestinal barrier function in patients with servere intra-abdominal infection. Methods A total of 40 patients with severe intra-abdominal infection proven by surgery were randomly assigned to receive either route therapy （n=20） or intravenous L-arginine hydrochlorlde at a dose of 0.3g/kg daily for 5 consecutive days in addition to the route treatment （n=20）. Plasma levels of endotoxin and D-lactate, and serum C-reactive protein （CRP） levels were detected in all of the patients 4 days before and after surgery. SIRS score, incidence of postoperative complications, and mean length of hospital stay were simultaneously documented. Results The plasma levels of endotoxin and D-lactate, serum CRP levels, and SIRS score in L-arginine group 4 days after operation, as compared with those in route treatment group, were significantly declined [ （0.27 ± 0.11 ）EU/L vs （0.39 ± 0.13）EU/ L, （2.47± 0.57）μg/L vs （3.87 ± 0.98）μg/L, （23.12 ±16.33）mg/L vs （39.30 ± 17.45）mg/L, and 0.76 ＋ 0.89 vs 1.41 ± 0.94, respectively; P 〈 0. 05], while the postoperative complications and the mean length of hospital stay did not differ between the two groups （P 〉 0.05）. Conclusion L-arginine can reduce the systematic inflammatory reaction and maintain the intestinal barrier function in patients with severe intra-abdominal infection.