静脉补充谷氨酰胺对外科手术新生儿喂养耐受的影响

Effect of parenteral glutamine supplementation on feeding tolerance in infants undergoing surgery

目的评价含丙氨酰谷氨酰胺（Ala-Gln）肠营养（PN）对接受外科手术新生儿喂养耐受的影响。方法对两家儿童医疗中心2006年1月至2007年1月收治的40例接受外科手术的新生儿进行研究，采用平行、随机、双盲、对照实验，随机分为常规PN组（对照组）和常规PN＋Ala-Gln组（研究组），二组各20例，对照组氨基酸的剂量为2～3g·kg^-1·d^-1；研究组添加0．3g·k^-1·d^-1Ala-Gin双肽，其中Ala-Gln双肽取代了处方中相应氨基酸的量。首要终点指标为术后开始喂养时间，术后达到全肠内喂养天数（标准配方摄人量≥120ml·k^-1·d^-1）、完全脱离肠外营养时间和病死率。结果研究组和对照组比较，患儿术后开始喂养时间[研究组（8±4）d，对照组（8±5）d]、术后达到全肠内喂养天数[研究组（14±8）次，对照组（15±7）次]以及完全脱离肠外营养时间[研究组（15±8）d，对照组（16±7）d]差异均无统计学意义。对照组有3例死亡，研究组患儿无死亡，病死率通过非意向性分析，二组比较差异有统计学意义，OR值为0．789，95％CI为0．626-0．996。但是通过意向性分析，OR值为0．706，95％CI为0．136-3．658，病死率比较差异没有统计学意义。结论本研究显示，静脉补充谷氨酰胺未能使接受外科手术的新生儿减少术后开始喂养时间和术后达到全肠内喂养天数，缩短全肠外营养应用时间；但关于是否能够降低患儿病死率，通过意向性分析和非意向性分析的结果有差异，尚需进一步研究。

Objective To assess the effects of parenteral nutrition （PN） with glutamine supplementation on feeding tolerance in infants undergoing surgery. Methods We preformed a multicenter, randomized, double-masked, clinical trial to assess the effects of PN supplemented with glutamine in infants undergoing surgery. Forty infants at two children centers were randomly assigned to either a control group （sPN; the dosage of amino acid according to Chinese guidelines for the use of nutritional support in critically ill neonates; n = 20） or a glutamine-supplemented group （GlnPN; glutamine intake, 0. 3g/kg.d;n = 20） from Jan 2006 to Jan 2007. The primary endpoints were the time to starting enteral nutrition and the time to achieving full enteral nutrition after surgery, duration of parenteral nutrition and mortality. Results There were no significant differences between the groups in the time to starting enteral nutrition after surgery [-GlnPN（8 ± 4）d vs. sPN（8 ± 5d）], the time to achieving full enteral nutrition after surgery [GlnPN（14 ± 8） vs. sPN （15 ± 7）1, duration of parenteral nutrition [GlnPN（15 ± 8）d vs. sPN （16 ± 7）d]. Of the 20 infants who were assigned to glutamine supplementation, no infant died, as compared with 3 of the 20 infants assigned to control group, according to nonintention to treat analysis： relative risk： 0. 789; 95 % confidence interval： 0. 626-0. 996; but according to intention to treat analysis： relative risk： 0. 706; 95 % confidence interval： 0. 136-3. 658. Conclusions Parenteral glutamine supplementation has no role in decreasing the time to starting enteral nutrition and achieving full enteral nutrition after surgery, duration of parenteral nutrition in infants undergoing surgery. But parenteral glutamine supplementation can decrease the mortality in children underwent surgery.