谷氨酰胺治疗对有营养风险肝胆手术病人临床结局影响研究

Influences of glutamine in hepatobiliary surgery patients with nutritional risk

目的观察肝胆手术病人营养风险的发生率,探讨谷氨酰胺(Glutamine,GLn)治疗对有营养风险病人临床结局的影响。方法采用队列研究的方法,连续定点采集2011年1月至2014年12月于广州军区武汉总医院行手术治疗的肝胆外科病人资料,用NRS2002评分标准,对≥3分的病人纳入研究。共402例病人,分Gln治疗组248例和非Gln组154例,观察两组住院时间和感染性并发症发生率。结果 Gln组和非Gln组感染性并发症分别为9例、14例(P<0.05),住院天数分别为(11.28±7.77)d、(12.03±9.02)d(P>0.05)。NRS评分≥5分的病人,Gln组(130例)和非Gln组(47例)病人的并发症分别为4例、6例,住院时间分别为(11.21±7.15)d、(12.73±1.26)d(P<0.05)。多因素logistic回归分析提示,Gln治疗是感染性并发症的保护因素,而NRS评分≥5分、术前GGT升高、术前前白蛋白降低是危险因素,其OR值分别为0.76、1.19、1.25、1.39,P值均小于0.05。结论 Gln治疗能显著降低存在营养风险肝胆外科手术病人的感染并发症发生率,且NRS评分≥5分的病人尚可缩短住院时间,更能从Gln治疗中获益。

Objective To observe the incidence of patient＇ s nutritional risk in hepatobiliary surgery.,and analyse the influences of glutamine treatment on these patients. Methods By continuously collecting the patients＇ data, who have been conducted the operation in general surgery of hospital of Guangzhou Military Command with the method of cohort study from January 2011 to December 2011. Including patients with NRS i〉 3, graded by NRS2002 scoring criteria. 402 cases of patients in total, 248 cases using glutamine treatment and 154 cases non glutamine treatment. Observing the hospital stay and incidence of infectious complications.Results The number of patients with infectious complications is 9 cases in glutamine group, and 14 cases in non glutamine group respectively （P 〈 0.05）; The hospital stay is （11.28±7.77 ）d ＆ （12.03±9.02 ）d （P 〉 0.05）. For the patients with NRS≥ 3, 4cases with infectious complications and 6 cases with glutamine group（130 cases） and non glutamine group （47 cases）, the hospital stay is （11.21±7.15）d ＆（12.73± 1.26） d （P 〈 0.05）. The results of logistic regression analysis suggest that glutamine is the protective factors. However, NRS ≥5, preoperative elevated GGT and preoperative lower prealbumin are independent risk factors, the OR values were 0.76, 1.19, 1.25 ＆ 1.39 respectively, and P〈0.05. Conclusions Glutamine can significantly reduce the incidence, shorten the hospital stay for patients in hepatobiliary surgery with nutritional risk, and the patients with NRS≥5 can benefit more from glutamine treatment.