谷氨酰胺强化的PN在左半结肠梗阻一期肠切除术后的临床应用

Clinical application of glutamine-enhancing PN on the postoperative patients of left colon resection

目的 观察符氨酰胺强化的PN对左半结肠梗阻一期肠切除术后的作用。方法选择广东医学院附属医院胃肠外科收治的左半结肠梗阻行一期肠切除术的患者37例，随机分成研究组18例和对照组19例；对照组术后常规肠外营养，研究组加用谷氨酰胺注射液，持续7d，比较两组患者的炎症反应和临床情况。结果研究组术后第7d白细胞计数、IL-6、APACHEII评分低于对照组[（6．4±1．1）×10^9／LVS（8．9±3．3）×10^9／L，（16．6±7．1）ng／LVS（28．6±10．3）ng／L，（4．64-1．8）分VS（7．3±2．5）分1，差异具有极显著性（P〈0．01）；研究组肠功能恢复时间短于对照组[（72．0±5．2）hVS（82．5±7．2）h]，差异具有极显著性（P〈0．01）；研究组的肺部感染率小于对照组（2／18VS8／19），差异具有显著性（P〈0．05）；两组患者切口感染率、吻合口瘘发生率（4／18VS6／19，2／18VS3／19）差异无显著性（P〉0．05），且研究组吻合口瘘发生时间较晚、全身炎症反应较轻，均保守治疗治愈，对照组2例经造瘘治愈。结论谷氨酰胺强化的PN能明显减轻左半结肠梗阻一期肠切除术的炎症反应，控制感染，保护和修复肠道粘膜，促进肠功能恢复，从而达到加速康复外科的作用。

Objective To investigate the effect of glutamine-enhancing parenteral nutrition （PN） on the postoperative patients of left colon resection. Methods 37 postoperative patients of left colon resection were randomly divided into study group （18） and control group （19）. Study group were treated with glutalnine-enhancing PN for 7 days. Control group were treated with normal PN for 7 days. The inflammatory response and the clinical features were compared. Resulta The white-blood eell count, IL-6 and APACHE II score of study group were lowered than those of control group on the 7th day, the difference was statistically significant （P〈 0.01）. The time of intestinal function recovery in study group were shorter than that of control group, the difference was statistically significant （P〈 0.01）. The incidence of lung infection in study group were less than those of control group, the difference was （P〈 0.05）. The incidence of wound infection, anastomotic leakage were not statistically significant （P〉 0.05）. However, the time of anastomotic leakage in study group was later, the inflammatory response was lighter. 2 patients of control group were cured by colostomy. Conclusions Glutamine-enhancing PN can significantly reduce the intestinal inflammatory response of left colonic excision, protect intestinal mucosa and promote the recovery of intestinal function, so as to achieve the effect of fast track surgery.