添加谷氨酰胺双肽的低热量肠外营养在高龄腹部手术病人的临床应用

Clinical application of lower caloric parenteral nutrition with glutamine dipeptide in elder abdominal surgical patients

目的 :探讨添加谷氨酰胺 (Gln)双肽的低热量肠外营养 (PN)在高龄腹部手术病人中的应用价值。 方法 :4 0例病人随机分成研究组和对照组 ,各 2 0例。所有病人术后第 1～ 6天接受等热量 83.6kJ/ (kg·d)、等氮 0 .16 g/(kg·d)的PN支持 ,研究组病人另增加 0 .3g/ (kg·d)的Gln双肽。术前及术后第 1、7天检测血清白蛋白、前白蛋白、IgG、IgA和IgM ,并进行淋巴细胞计数 (LCC)。计算术后第 1、4、7天氮平衡。 结果 :两组病人术后血清白蛋白和前白蛋白值均较术前下降 ,对照组下降明显 (P <0 .0 5 ) ;术后LCC均较术前升高 ,尤以研究组升高显著 (P <0 .0 1)。累积氮平衡研究组明显高于对照组 (P <0 .0 5 )。未观察到不良反应或并发症。 结论 :添加Gln双肽的低热量肠外营养在高龄腹部手术病人中使用安全 ,具有改善氮平衡。

Objectives: To study the value of glutamine dipeptide supplemented lower caloric parenteral nutrition in elder abdominal surgical patients. Methods:Forty patients were randomly allocated into study group and control group, receiving isocaloric (83.6 kJ/kg·d -1 ) and isonitrogenous (0.16 g/kg·d -1 ) PN from post operation day1 to post operation day 6. The study group received 0.3 g of alanyl glutamine/(kg·d)? Plasma albumin, pre albumin, IgG, IgA and IgM level were measured and lymphocyte was counted before surgery and on days 1 and 7 after surgery. Nitrogen balances were calculated postoperatively on day 1, 4 and 7. Results:Compared with preoperation, plasma albumin and pre albumin levels were both decreased in two groups and was markedly decreased in the control group ( P < 0.05 ) after operation; lymphocyte count was both increased in two groups and was markedly increased in the study group ( P <0.01) after operation. Cumulative nitrogen balance in the study group was significantly higher than that in control group ( P <0.05). No side effects or complications of nutrient fluid were noted. Conclusions:Glutamine dipeptide supplemented lower caloric parenteral nutrition could be safely used in elder abdominal surgical patients. It helps to improve nitrogen balance, to lessen the decrease of serum albumin and to increase the lymphocyte count.