谷氨酰胺治疗严重烧伤患者蛋白代谢的随机对照双盲试验

Random pairs and double-blind study of glutamine on protein metabolism in severe burn

目的 观察严重烧伤患者蛋白代谢的变化及口服谷氨酰胺对其的影响。方法 采用随机对照双盲试验 ,将烧伤总面积在 30 %～ 60 % ,Ⅲ度烧伤面积在 2 0 %～ 50 %的 39例患者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 ,1 9例 )。GLN组每日服用谷氨酰胺颗粒剂 0 5g/kg。C组服用同等剂量的安慰剂 ,疗程为 7d。检测用药前后两组病人血中谷氨酰胺浓度、血浆蛋白含量、尿氮排量 ,并记录患者的一般情况及 30d创面愈合率和住院天数。结果GLN组病人用药 7d后 ,血浆谷氨酰胺、前白蛋白及转铁蛋白含量均显著高于用药前和C组 (P <0 0 1 ) ,血浆总蛋白、白蛋白明显高于用药前 ,但与C组相比无显著性差异 (P>0 0 5)。而GLN组的尿氮排量明显低于C组 ,且 30d创面愈合率和住院时间均优于C组。结论 服用谷氨酰胺能显著提高严重烧伤患者血中谷氨酰胺水平 ,促进机体蛋白合成 ,减少蛋白分解 ,提高 30d创面愈合率 。

Objective To study the effect of glutamine on protein metabolism in severe burned patients. Methods Thirty nine severe burn patients with total burn surface area of 30%～60% and full thickness burn area of 20%～50% were randomly divided into 2 groups: control (C, 19 patients) and glutamine treatment group (GLN group, 20 patients). The former were give placebo 0 5 g·kg -1 ·d -1 for 7 d and the later received glutamine granules in a same way. The concentrations of plasma glutamine and proteins and urine nitrogen were determined. Wound healing rate 30 d after hospitalization and hospital duration were recorded. Results After 7 d of medication, the plasma concentrations of glutamine, prealbumin and transferrin were significant higher in the patients of GLN group than them before medication and those of C group ( P <0 01), and total protein and albumin concentrations were obviously higher in GLN group than in them before the treatment ( P <0 01), but had no difference with C group. On the other hand, the content of urinenitrogen was lower in GLN group than in C group. In addition, the wound healing became faster and hospital duration was shorter in GLN group than C group ( P <0.01). Conclusion Taking glutamine could promote protein synthesis, abate protein decompose, increase wound healing rate and reduce hospital duration obviously in burned patients.