重度创伤患者使用精氨酸的安全性研究

Safety Research of Arginine in Treatment of Patients with Severe Trauma

目的探讨精氨酸对重度创伤患者安全性的影响。方法选择简化损伤分级(AIS)-90创伤评分为16～25分的重度创伤患者37例,根据是否服用精氨酸随机分为对照组和精氨酸组(30 g/d),观察14d。采用等氮等热卡营养支持,术后1d、14d测定两组肝、肾功能,记录感染并发症和胃肠道症状,采用卡方检验、球形检验和独立样本t检验。结果精氨酸组、对照组术后14d丙氨酸转氨酶均显著高于术后1d,差异均有统计学意义(P=0.022,0.007),两组间比较差异亦有统计学意义(P=0.017)。精氨酸组术后14d尿素较术后1d升高,但差异无统计学意义(P>0.05);对照组术后14d较术后1d降低,但差异无统计学意义(P>0.05)。精氨酸组、对照组感染率分别为5.9%、25.0%,差异有统计学意义(P=0.009);两组各种胃肠道症状发生率差异无统计学意义(P>0.05)。结论 AIS-90创伤评分16～25分的重度创伤患者应用30 g/d精氨酸安全可靠。

Objective To explore the safety of arginine in treatment of patients with severe trauma.Methods Thirty-seven cases of severe trauma,whose trauma score were 16-25 points by abbreviated injury score（AIS）-90 scores standard,were randomly divided into control group and arginine group（30 g/d） according to the arginine oral dose.The patients in two groups had been observed for fourteen days.The patients＇ indexes of liver function and renal function were measured respectively on the first day and the fourteenth day after operation by nutritional support with the same nitrogen and calorie.Meanwhile,the infection complications and gastrointestinal symptoms were recorded.The data was analyzed by Chi-square test,mauchly＇s test of Sphericity and independent samples test.Results The indexes of patients＇ the alanine aminotransferase in two groups on the fourteenth day after operation were respectively significantly higher than those on the first day after operation（P=0.022,P=0.007）,and the difference between control group and arginine group was also statistically significant（P=0.017）.The index of renal function about the urea in arginine group on the fourteenth day after operation was higher than that on the first day after operation,but the difference was not statistically significant（P0.05）,and in control group on the fourteenth day after operation it was higher than that on the first day after operation,and the difference was not statistically significant,either（P0.05）.The infection rates in arginine group and control group were 5.9% and 25.0% respectively,and the difference was statistically significant（P=0.009）.The difference in incidence rates of gastrointestinal symptoms between the control group and arginine group was not statistically significant（P0.05）.Conclusion It should be safe for the patient with severe trauma,whose trauma score is 16~25 by the AIS-90 scores standard to take arginine dose（30 g/d） orally.