丙氨酰谷氨酰胺联合肠外营养液治疗重症肠瘘24例临床评价

Clinical Efficacy of Alanyl Glutamine Combined with Parenteral Nutrition Fluid for Treating Severe Intestinal Fistula in 24 Cases

目的探讨肠外营养(TPN)联用丙氨酰谷氨酰胺(Gln)对重症肠瘘患者的疗效。方法将48例重症肠瘘患者随机分为Gln组和常规组,各24例。两组全肠外营养热卡和氮量基本一致,均采用高热量、高氮量的营养配方进行营养支持,Gln组在上述治疗基础上加用丙氨酰谷氨酰胺0.4g/(kg·d)。治疗前、治疗后第5天和第10天采血检测营养指标、免疫指标、肠黏膜通透性等指标,并进行对照比较分析。结果两组患者在营养、免疫功能方面均得到改善,负氮平衡得到纠正;与常规组比较,Gln组治疗后改善患者营养、提高免疫功能、纠正负氮平衡效果更好(P<0.05),白细胞计数更加降低(P<0.05),血浆Gln升高、血浆内毒素(LPS)和肿瘤坏死因子-α(TNF-α)降低更明显(P<0.05)。结论丙氨酰谷氨酰胺联合肠外营养液,能改善重症肠瘘患者的肠道屏障功能,从而改善患者生活质量。

Objective To explore the clinical effect of total parenteral nutrition（TPN） combined with alanyl glutamine（Gln） in the pa-tients with severe intestinal fistula.Methods By using the randomized controlled method,48 patients with severe intestinal fistula were divided into the Gln group and the control group,24 cases in each group.The TPN calories and the nitrogen amount in the two groups were basically consistent.The two groups all adopted the nutrient formula of high calories and high nitrogen amount for conducting the nutrition support.The Gln group added Gln 0.4g/（kg·d） on the basis of the above therapy.The blood sample collection was per-formed before treatment and on 5,10d after treatment for detecting the nutrition indexes,immune indexes,intestinal mucosal permeabili-ty,etc.The comparative and contrasting analysis was conducted.Results The two groups were improved in the aspects of nutrition and immunity,and the negative nitrogen balance was corrected;compared with the control group,the Gln group had better effects in the as-pects of the nutrition improvement,immunity enhancement and correcting the negative nitrogen balance after treatment（P 0.05）;the WBC count was much lower（P 0.05）;plasma Gln level was increased,the decrease of LPS and TNF-α was more significant（P 0.05）. Conclusion Gln improves the intestinal barrier function in the patients with severe intestinal fistula,thus improves the patient＇s life quality.