添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免疫功能、营养状态及术后恢复的临床意义

Alanyl-Glutamine Supplementation in Total Parenteral Nutrition in Gastric Cancer Operation Patients of Nutritional Risk: the Clinical Significance on Immune System,Nutritional Status and Postoperative Recovery

目的:本研究旨在探讨NRS评分大于5分的胃癌根治术患者围手术期应用丙氨酰谷氨酰胺(Ala-Gln)强化的肠外营养对免疫功能、营养状况及术后恢复情况的临价值。方法:NRS-2002评分大于5分的胃癌患者60例,随机分为两组,每组30例。术前开始给予肠外营养支持,5日后手术,手术方式为根治性胃切除,包括远端胃大部切除术和全胃切除术。术后继续给予常规肠外营养。只有实验组给予谷氨酰胺双肽每日20克。于入院时和手术后第6日测量CD4、CD8、CD4/CD8、IgG、IgA、IgM淋巴细胞计数等免疫指标,血清总蛋白、白蛋白、谷丙转氨酶、总胆红素、血肌酐等肝肾功能指标,观察手术恢复过程及术后并发症发生情况。结果:采用谷氨酰胺强化的试验组CD4、CD8等免疫指标恢复情况显著优于对照组。二者一过性肝功能损伤发生率无明显差异。但试验组白蛋白较对照组恢复迅速。试验组术后肠蠕动恢复较对照组快,术后腹泻发生率较低。两组在术后抗生素应用时间、术后感染等发病率方面未显示统计学差异。结论:对存在营养风险的胃癌患者进行围手术期静脉营养支持时添加谷氨酰胺制剂可明显改善患者的免疫状况,促进术后恢复减少手术并发症。

Objective： This research is to evaluate clinical significance ofparenteral alanyl-glutamine bipeptide supplementation o- n immunological and nutritional status and postoperative recovery in stomach cancer patients of nutritional risk who received radical ope- ration. Methods： Nutrition risk screening was undertaken by NRS-2002. Sixty patients of over 5 marks were enrolled in this study and were randomized into 2 groups of 30 patients. Parenteral nutritional support was given 5 days before ：radical gastrectomy. Parental nutrition was continued while only the experiment group was prescribed alanyl-glutamine. Immunological markers, hepatic and renal function markers were monitored by the time of in-charge and 6 days after surgery. The postoperafive recovery procedure and complications were carefully recorded. Results： The immune markers of CD4 and CD8 were markedly enhanced in the glutamine group comparing the control groups. There was no significant difference in the incidence of transient hepatic injury. The glutamine group showed a faster albumin restoration, and intestinal peristalsis recovery was also significantly faster in the glutamine group. Diarrhea was less frequent in the glutamine group. Other clinical parameters such as the duration of antibiotic usage, the incidence of postoperative infection revealed no significant differences. Conclusion： For surgical patients with nutritional risk, total parenteral nutrition with glutamine supplementation in the perioperative period may enhance their immune response, promoting postoperative recovery reduce operation complications.