谷氨酰胺连续输注对腹部手术患者术后肠道屏障功能的影响

Effects of Continuous Infusion of Glutamine on Intestinal Barrier Function After Abdominal Surgery

目的:探讨谷氨酰胺连续输注对腹部手术患者术后肠道屏障功能的影响。方法:回顾性选取广州市花都区第二人民医院普外科行腹部手术治疗的患者70例,根据营养支持方法的不同分为观察组和对照组各35例,观察组患者于术后1 d即经鼻胃管连续肠内营养支持治疗5 d(营养液中添加谷氨酰胺),对照组患者术后进行常规肠内营养支持治疗,比较两组患者术后肠道屏障功能变化情况,腹泻、呕吐及反流发生率和肠道细菌移位情况。结果:治疗后,观察组患者的肠黏膜通透性(乳果糖/甘露醇的比值)明显低于治疗前和对照组治疗后;观察组患者肠道粪便培养乳酸杆菌、双歧杆菌的菌株数所占比例明显高于对照组,大肠杆菌、酵母菌的菌株数所占比例明显低于对照组,上述差异均有统计学意义(P<0.05)。观察组治疗方案并不增加并发症发生概率,观察组患者中仅2例出现呕吐,无反流现象,而腹泻发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:谷氨酰胺连续输注用于腹部手术患者术后,可改善肠道屏障功能,预防细菌移位,是纠正术后营养状态和肠道功能的重要措施。

OBJECTIVE： To investigate the effects of continuous infusion of glutamine on intestinal barrier function after abdominal surgery. METHODS： 70 patients undergoing abdominal surgery in general surgery department of the Second People＇s Hospital of Guangzhou Huadu District were retrospectively extracted to be divided into observation group and control group according to different nutritional support methods（ 35 cases in each）. Patients in observation group received continuous enteral nutrition support through nasogastric tube for 5 d after surgery（ glutamine was added to the nutrient solution）,and the control group was given conventional enteral nutrition support after surgery. Changes of postoperative intestinal barrier function,the incidence of diarrhea,vomiting,regurgitation and intestinal bacterial translocation were compared between two groups. RESULTS： After treatment,the intestinal mucosal permeability（ lactose/mannitol ratio） in observation group was significantly lower than that before treatment and the control group after treatment. The proportion of strains of lactobacilli and bifidobacteria in the intestinal feces of observation group was significantly higher than that of control group and the proportion of the strains of E. coli and yeast was significantly lower than that of control group,with statistically significant differences（ P〈0. 05）. The treatment regimen of observation group did not increase the probability of complications,only 2 patients in observation group had vomiting,no reflux phenomenon,and the incidence of diarrhea was significantly lower than that of control group,the difference was statistically significant（ P〈0. 05）. CONCLUSIONS： Continuous infusion of glutamine for postoperative patients with abdominal surgery can improve intestinal barrier function and prevent bacterial translocation. It is an important measure to correct postoperative nutritional status and intestinal function.