谷氨酰胺对多器官功能障碍综合征患者血浆内毒素水平的影响

Effect of total parenteral nutrition with glutamine on the plasma endotoxin of the MODS patients

目的:探讨添加谷氨酰胺(Gln)的全肠外营养(TPN)对多器官功能障碍综合征(MODS)患者血浆内毒素(LPS)水平的影响。方法:将入住聊城市人民医院ICU的MODS患者40例随机分为A组、B组。A组按常规给予TPN,B组在给予TPN基础上加用Gln0.27g.kg-1.d-1,共7d。TPN治疗前及治疗后第1,3,7天检测血浆Gln、LPS浓度,观察TPN治疗时间、死亡率。选取健康献血员作C组。结果:血浆Gln浓度TPN治疗前A、B两组均显著低于C组(P<0.01),两组间无显著性差异(P>0.05)。TPN治疗第1,3,7天,A组显著低于B组(P<0.01)。血浆内毒素浓度TPN治疗前A、B两组显著高于C组(P<0.01),A、B两组间无显著性差异(P>0.05),经Gln+TPN治疗后,B组血浆LPS显著低于A组(P<0.01)。A组TPN治疗时间为(15.8±2.3)d,B组为(12.5±2.4)d,A组显著高于B组(P<0.05)。A组死亡率为25%,B组为10%,两组间比较无显著性差异(P>0.05)。结论:经静脉补充Gln(力肽),显著降低MODS患者血浆LPS浓度,有利于缩短TPN治疗时间。

ORJECTIVE To determine the effect of total parenteral nutrition（TPN） supplemented with glutamine（Gln） on the concentration of plasma lipopolysaccharide （LPS）of the multiple organ dysfunction syndrome（MODS） patients. METHODS 40 MODS patients in the ICU were randomed divided into routine group A and B. Group A were given routine TPN, and Group B were given routine TPN and Gln 0. 27 g. kg^-1·d^-1 for seven days. The concentration of plasma Gln and LPS were checked before the treatment of TPN and on the first, the third and the seventh day after the treatment of TPN. At the same time 20 healthy blood donators were chosen as Group C. RESULTS Before treatment the concentration of plasma Gln of the two patient groups were both apparently lower than that of Group C （P〈0. 01）, and there was no apparent difference between Group A and Group B （P〉0. 05）. On the first, the third and the seventh day of the treatment of TPN, the concentration of plasma Gln of Group A was apparently lower than that of Group B （P〈0. 01 ）. Before treatment the concentration of plasma LPS of the two patient groups were apparently higher than that of Group C （P〈0. 01 ）, and there was no apparent differenee between that of Group A and Group B （P〉0.05）. After the treatment of Gln plus TPN, the concentration of plasma LPS of Group B was apparently lower than that of Group A （P〈0. 01 ） o The TPN treatment time was 15. 8 ± 2.3 days for Group A, 12. 5 ± 2.4 days for Group B. The time for Group A is apparently higher than that for Group B （P〈0. 05）. The death rate of Group A was 25%, the death rate of Group B was 10%, and there was no apparent difference between the two groups（P〉 0. 05）. CONCLUSION The Gln （dipeptiven）complementarity through vein can help to decrease the concentration of plasma LPS and also it can help to shorten the TPN treatment time of the MODS patients.