谷氨酰胺强化的肠内营养对手术应激患者肠黏膜通透性的影响

Influence of alanyl-glutamine-enriched enteral nutrition on intestinal permeability of patients with abdominal surgical stress response

目的研究谷氨酰胺强化的肠内营养对手术患者肠黏膜通透性的影响。方法 216例消化道手术患者随机分为肠外营养（PN）组、肠内营养（EN）组和谷氨酰胺强化的肠内营养（GLN）组。3组患者分别于术后3-11 d给予等氮、等能量（氮0.2 g.kg-1.d-1,能量125.4 kJ.kg-1.d-1）的营养治疗。观察术前1 d、术后7 d和术后12 d口服含乳果糖10 g、甘露醇5 g的测试液后6 h尿中乳果糖和甘露醇排泄率的比值（L/M）变化,用高效液相色谱法测定尿中乳果糖和甘露醇的浓度。结果 3组术后7 d、12 d甘露醇浓度与术前比较无明显差异,3组术前及术后7 d、12 d甘露醇浓度组间比较差异无统计学意义。术前、术后7 d和术后12 d L/M比值在GLN组分别为0.025±0.009、0.038±0.017、0.028±0.012;EN组分别为0.024±0.011、0.061±0.019、0.027±0.014;PN组分别为0.026±0.012、0.083±0.021、0.047±0.013。统计学分析表明,术后7 d三组L/M比值较术前均升高（P〈0.05）,PN组高于EN组和GLN组（P〈0.05）,EN组高于GLN组（P〈0.05）;术后12d L/M比值PN组仍高于术前及EN组和GLN组（P〈0.05）,而EN组与术前和GLN组比较差异无统计学意义。结论术后早期肠黏膜通透性升高,肠内营养有利于维护肠黏膜屏障功能,谷氨酰胺强化的肠内营养有助于加强肠黏膜屏障功能。

Objective To investigate the influence of alanyl-glutamine-enriched enteral nutrition on the intestinal permeability in patients with abdominal surgical stress response.Methods A total of 216 patients undergoing abdominal surgery were randomly divided into three groups,namely,the conventional alanyl-glutamine-enriched enteral nutrition（GLN group）,enteral nutrition（EN group） and parenteral nutrition（PN group）.The three groups were given isonitrogenic（0.2 g· kg-1·d-1） and isocarloric（125.4 kJ·kg-1·d-1） support during 3-11 days after operation.The urinary lactulose/mannitol（L/M） ratios were observed 6 h after the patients were given 10 g lactulose and 5 g mannitol on one day before and the 7th,12th day after operation.High pressure liquid chromatography was used to determine the urinary levels of lactulose and mannitol.Results The mannitol levels had no significant change before and 7,12 days after operation in the 3 groups,and there were also no significant difference between the 3 groups before and 7,12 days after operation.The L/M values before and 7,12 days after operation were 0.025±0.009,0.038±0.017,and 0.028±0.012 in GLN group,0.024±0.011,0.061±0.019,and 0.027±0.014 in EN group,and 0.026±0.012,0.083±0.021,and 0.047±0.013 in PN group,respectively.Statistical analysis showed that the L/M ratios in the 3 groups were all significantly increased 7 days after operation compared with those before operation（P0.05）,and that of PN group was significantly higher than those of EN group and GLN group（P0.05）,and that of EN group was significantly higher than that of GLN group（P0.05）.Twelve days after operation,the L/M ratios in PN group was still significantly higher than that before operation and those in the EN and GLN groups（P0.05）,and that in EN group was similar to that before operation and that in GLN group.Conclusion The intestinal permeability is greatly increased during the early period after operation.Enteral nutrition is favorable for maintaining the function of intestinal mucosal barrier.Alanyl-glutamine-enriched enteral nutrition can improve the function of intestinal mucosal barrier.