谷氨酰胺联合乌司他丁、亚胺培南对急性重症胰腺炎患者肠黏膜屏障功能和营养状态的影响

Effects of glutamine combined with ulinastatin and imipenem on the intestinal mucous membrane barrier function and nutritional status in patients with severe acute pancreatitis

目的探讨谷氨酰胺联合乌司他丁、亚胺培南对急性重症胰腺炎患者肠黏膜屏障功能和营养状态的影响。方法选取2015年3月至2018年3月收治的急性重症胰腺炎患者80例,随机分为对照组和治疗组,每组40例。对照组给予乌司他丁、亚胺培南治疗,治疗组在对照组基础上给予谷氨酰胺治疗,疗程均为2周。观察2组血清D-乳酸、二胺氧化酶(DAO)、尿乳果糖/甘露醇(L/M)、血浆内皮素(ET)、一氧化氮(NO)、血栓素B_2(TXB_2)和6-酮-前列腺素F1a(6-keto-PGF1a)、丙二醛(MDA)、超氧化物歧化酶(SOD)、白蛋白(ALB)、转铁蛋白(TF)水平变化。结果治疗前2组血清D-乳酸、DAO、尿L/M、血浆ET、NO、TXB_2、6-keto-PGF1a、MDA、SOD、ALB、TF比较差异无统计学意义(P>0.05)。治疗后2组血清D-乳酸、DAO、尿L/M、血浆ET、NO、TXB_2、MDA均显著降低,血浆6-keto-PGF1a、SOD、ALB、TF均显著升高,差异有统计学意义(P<0.05);且治疗组D-乳酸、DAO、L/M、ET、NO、TXB_2、MDA低于对照组,6-keto-PGF1a、SOD、ALB、TF高于对照组,差异有统计学意义(P<0.05)。结论谷氨酰胺联合乌司他丁、亚胺培南治疗急性重症胰腺炎疗效确切,能够保护肠黏膜屏障功能,改善微循环及营养状态。

Objective To observe the effects of glutamine combined with ulinastatin and imipenem on the intestinal mucous membrane barrier function and nutritional status in patients with severe acute pancreatitis. Methods A total of 80 patients with severe acute pancreatitis who were treated in our hospital from March 2015 to March 2018 were randomly divided into control group and treatment group,with 40 patients in each group.The patients in control group were treated by ulinastatin and imipenem ,however,the patients in treatment group,on the basis of control group,were treated by glutamine,with a treatment course of 2 weeks for both groups. The changes ogf the serum levels of D-lactic acid, DAO,urinary lactulose/mannitol (L/M) ratio,plasma ET,NO,TXB2,6-keto-PGF1a, MDA,SOD,ALB and TF were observed and compared between the two groups. Results Before treatment there were no significant differences in the levels of D-lactic acid, DAO,urinary lactulose/mannitol (L/M) ratio,plasma ET,NO,TXB2,6-keto-PGF1a,MDA,SOD,ALB and TF between the two groups ( P >0.05).After treatment the levels of D-lactic acid,DAO,L/M,ET,NO,TXB2 and MDA were significantly decreased in both groups,however,the levels of 6-keto-PGF1a,SOD,ALB and TF were significantly increased in both groups ( P <0.05).Moreover the levels of D-D-lactic acid,DAO,L/M,ET,NO,TXB2,MDA in treatment group were significantly lower than those in control group,and thelevels of 6-keto-PGF1a, SOD,ALB,TF in treatment group were significantly higher than those in control group were significantly ( P <0.05). Conclusion The glutamine combined with ulinastatin and imipenem in treatment of severe acute pancreatitis can obtain satisfactoty therapeutic effects,which can protect intestinal mucous membrane barrier function and improve microcirculation and nutritional status of patients.