TPN,丙氨酰-谷氨酰胺双肽在重症急性胰腺炎非手术治疗中的意义

Effect of the application of total parenteral nutrition (TPN) and glutamine-supplemented TPN on patients with serious acute pancreatitis

目的 观察全胃肠外营养、全胃肠外营养 +丙氨酰 -谷氨酰胺双肽在急性重症胰腺炎非手术治疗中的作用 .方法 6 4例急性重症胰腺炎依据不同治疗方案随机分为 3组 . I组采用传统保守治疗方案 ,将 II组在传统保守治疗原则基础上实施全胃肠外营养 (TPN)治疗 ,III组在 II组方案基础上给予丙氨酰 -谷氨酰胺双肽治疗 ,观察各组血清白蛋白水平、血淀粉酶恢复正常时间、并发症发生率、死亡率、患者住院日数、体质量并加以比较 .结果 3组患者入院时血清白蛋白分别为 (2 8.7± 4 .92 ) g· L- 1 (I组 )、(2 9.1± 4 .84 ) g· L- 1 (II组 )和 (2 9.3± 4 .5 0 ) g· L- 1 (III组 ) ,治疗 2 wk后 I组、II组和 III组血清白蛋白分别为 (30 .1± 4 .5 3) ,(35 .7± 4 .6 2 )和 (36 .8± 4 .5 7) g· L- 1 ,3组死亡率分别为 34.8% (8/ 2 3) ,14 .3%(3/ 2 1)和 0 % ,并发症发生率分别为 91.3% (2 1例次 / 2 3)、4 7.6 % (10例次 / 2 1)、2 0 .0 % (4例次 / 2 0 ) ,其中 III组未出现胰腺周围感染 .患者体质量变化 I组与 II,III组相比差异显著 .结论 在急性重症胰腺炎传统的非手术治疗方案基础上 ,给予 TPN或 Ala- Gln强化 TPN治疗 ,可明显改善患者的营养状态 ,减少死亡率及并发症的发生率 .同时 ,Ala- Gln强化

AIM To investigate the effect of total parenteral nutrition (TPN) and glutamine supplemented TPN on patients with serious acute pancreatitis (SAP). METHODS Sixty four patients with SAP were randomly divided into 3 groups according to different therapeutic programs. Twenty three cases in Group I were treated by traditional method only; combined with traditional therapy, 21 cases in Group II and 20 cases in Group III were treated by TPN and glutamine supplemented TPN respectively. The concentration of serum albumin, recovery time of blood amylase, the incidence of complications, mortality, hospitalization time and body mass of the patients in each group were observed respectively. RESULTS The concentration of serum albumin in Group I, II, and III were (28.7±4.92), (29.1±4.84) and (29.3±4.50) g·L -1 respectively at the beginning of hospitalization. After 2 wk treatment, the serum albumin concentration of patients in Group II and III [(35.7±4.62) g·L -1 and (36.8±4.57) g·L -1 ] respectively increased significantly, but remained in Group I (30.1±4.53) g·L -1 . Mortalities of Group I, II, and III were 34.8% (8/23), 14.3% (3/21), 0% respectively. The incidence of complications in Group I (21/23) was much higher than that in Group II (10/21) and Group III (4/20). The complication rate in Group III was much less than that in Group II, and no pancreatic infection occurred in Group III. The body mass loss of patients in Group I was more significant than that in Group II and III. CONCLUSION Combined with conventional therapy, TPN and glutamine supplemented TPN therapy can reduce the mortality and morbidity of complications and improve the nutrition state of patients with SAP. Glutamine supplemented TPN therapy can also prevent the patients from pancreatic infection effectively.