谷氨酰胺保护严重烧伤病人肠粘膜屏障功能的研究

Study of protective effects of glutamine on intestinal mucosal barrier function in severe burned patients

目的 :观察严重烧伤病人肠粘膜屏障功能的变化及口服谷氨酰胺颗粒剂对它的影响。 方法 :采用随机双盲对照法 ,将烧伤总面积在 30 %～ 6 0 %、三度烧伤面积在 10 %～ 30 %的 39例病人 ,随机分为谷氨酰胺治疗组 (Gln组 2 0例 )和安慰剂对照组 (C组 19例 )。Gln组每天服用谷氨酰胺颗粒剂 0 .5 g/kg。C组服用同等剂量的安慰剂 ,疗程为 7天。检测用药前后两组病人血中谷氨酰胺浓度、二胺氧化酶 (DAO)活性、内毒素含量及肠粘膜通透性的变化 ,并记录一般情况和住院日。 结果 :Gln组病人用药 7天后 ,血中谷氨酰胺含量明显高于C组 (P <0 .0 1) ,而血浆DAO活性、内毒素含量及肠粘膜通透性均显著低于C组 (P <0 .0 1) ,住院日显著短于C组。 结论 :服用谷氨酰胺颗粒剂能显著提高严重烧伤病人血中谷氨酰胺水平 ,减轻伤后肠道受损程度 ,保护肠粘膜屏障 ,并有助于缩短住院日。

Objectives:To study the protection effect of glutamine on intestinal mucosal barrier function in severe burned patients. Methods:39 severe burn patients (total burn surface area was 30%~60%,full thickness burns area was 10%~30%) were randomly divided into two groups:control group(C group,19 patients) and glutamine treatment group (Gln group,20 patients).Gln group patients had been given glutamine granules 0.5 g/kg daily for 7 days, and C group had been given same weight placebo for 7 days.The plasma glutamine concentration,the activity of diamine oxidase(DAO) and intestinal mucosal permeability were determined,wound healing rate of burn area was observed,and then hospital stay was recorded. Results:After 7 days of oral glutamine intake, plasma glutamine concentration in Gln group was significantly higher than that in C group( P <0.01).On the other hand,the degree of intestine damage and intestinal mucosa permeability in Gln group were lower than those in C group.In addition,the wound healing was faster and hospital stay days was shorter than in C group( P <0.01). Conclusions:Taking L glutamine could abate the degree of intestine injury,lessen intestinal mucosal permeability,ameliorate wound healing rate and reduce hospital stay obviously.