谷氨酰胺在老年危重病患者中的应用价值

Clinical Effects of Glutamine Administration on Elderly Patients with Critical Illnesses

目的研究谷氨酰胺(glutamine,Gln)对老年危重患者肠功能、营养状况、免疫功能等的影响,评价Gln对老年危重病患者的应用价值。方法将65例老年重症监护病房患者随机分成丙氨酰-谷氨酰胺(alanyl-glutamine,Ala-Gln)治疗组(Gln组50例)和常规治疗对照组(15例),两组予以同样的常规治疗,包括基础疾病治疗、营养支持、对症治疗等。Gln组在常规治疗基础上给予Ala-Gln 100 ml(含丙氨酰8.20 g,Gln 13.46 g)加入氨基酸注射液500 ml内,配制成600 ml溶液,每日1次静脉滴注,连续使用2周。两组患者均于入住重症监护病房当天及治疗第15天测定血浆总蛋白、白蛋白、前白蛋白及免疫球蛋白IgG、IgA、IgM量;统计两组患者治疗前后肠功能评分及多脏器功能障碍发生情况。结果经应用Ala-Gln,Gln组除总蛋白外,白蛋白、前白蛋白、IgA、IgG和IgM 5项均高于治疗前及对照组(P<0.05或0.01);对照组治疗前后上述各指标变化无统计学差异(P>0.05)。Gln组和对照组治疗前肠功能评分比较无统计学差异(P>0.05);治疗后Gln组肠功能评分下降,与对照组比较有统计学差异(P<0.05)。Gln组合并功能障碍的脏器数目较对照组少(P<0.05)。结论 Gln可改善老年危重病患者的肠功能、营养状况和免疫功能,减少多脏器功能障碍的发生。

Objective To observe the clinical effects of alanyl-glutamine dipeptide administration on the gastrointestinal function, nutrition states and immune function of the elderly patients with critical illness. Methods A total of 65 elderly patients in ICU were randomly divided into placebo control group （group P） with 15 cases and alanyl-glutamine dipeptide group （group GIn） with 50 cases. Both groups were administrated with equal routine treatment （including primary diseases treatment, nutrition treatment and symptomatic treatment etc）, during which Group GIn was supplemented with 20 g alanyl-glutamine amid 500 ml amino acid intravenous drip everyday in two weeks. Before and after the treatment, both groups were monitored over their intestinal functions scores, incidence rates of multiple organ dysfunction syndrome （MODS） and total protein, albumin, proalbumin , IgG, IgA, IgM. Results In group GIn, all indexes except plasma total protein were higher after treatment than before treatment （P〈0. 05）. There was no significant difference in these indexes in group P before and after treatment （P〉0. 05）. There intestinal function scores was not different between group GIn and group P before treatment （P〉0. 05） and decreased after treatment in group GIn which was significantly different from that in group （P〈0. 05）. The incidence rates of MODS were lower in group GIn after treatment than those before treatment （P〈0. 05）, and was not significantly different in group P （P〉0. 05）. Conclusion Administration of Aln-Gln dipeptide can maintain intestinal function, improve normal nutritional status and immune function and reduce the incidence of MODS in the elderly patients with critical illnesses.