丙氨酰谷氨酰胺对出血性脑血管病患者营养状况的影响

Influence of Alanylglutamine on Nutritional Status of Patients with Hemorrhagic Cerebrovascular Disease

目的:观察谷氨酰胺(glutamine,GLN)强化的肠外营养干预对出血性脑血管病(hemorrhagic cerebrovascular disease,HCVD)住院患者营养相关指标及体格指标的变化。方法:选取2018年9月~2019年9月在本院就诊的符合纳入和排除标准的HCVD术后患者,依据随机数字表法分为干预组(39例)和对照组(39例),术后d 3~d 9经肠外营养予干预组丙氨酰谷氨酰胺注射液0.3 g/(kg·d),予对照组等氮量氨基酸注射液,观察两组HCVD患者术后d 3,d 10,d 17和d 24的体格及营养相关指标(血红蛋白、白蛋白、总蛋白、上臂围、肱三头肌皮褶厚度、上臂肌围及小腿围)。结果:干预组的上臂围在术后d 3~d 17、术后d 3~d 24的减少量分别为(0.7±0.4)cm(P=0.011)、(0.8±0.5)cm(P=0.011),均小于对照组。干预组的上臂肌围在术后d 3~d 17、术后d 3~d 24的减少量分别为(0.7±0.5)cm(P=0.010)、(1.0±0.7)cm(P=0.008),均小于对照组。而其他指标则未观察到此现象。结论:含谷氨酰胺的肠外营养配方可改善HCVD术后患者住院期间肌肉组织丢失的情况。

Objective:To observe the changes of nutrition-related and physical characters of patients with hemorrhagic cerebrovascular disease(HCVD)by glutamine-enhanced parenteral nutrition support.Methods:From September 2018 to September 2019,postoperative patients who met the criteria for admission were selected and divided into intervention groups(n=39)and controls(n=39)by random number method.Intervention group were given 0.3 g/(kg·d)alanylglutamine injection from 3 to 9 days after operation,while control group with amino acid injection of the same amount.Patients physical and nutritional characters(hemoglobin,albumin,total protein,mid-upper arm circumference,triceps skinfold thickness,mid-upper arm muscle circumference,and calf circumference)were tested at 3,10,17and 24 days after surgery.Results:In the intervention group,the decrease of mid-upper arm circumference from 3 days to 17 days after operation,and from 3 days to 24 days after operation were(0.7±0.4)cm(P=0.011)and(0.8±0.5)cm(P=0.011)respectively,and the decrease of mid-upper arm muscle circumference from 3 days to 17 days after operation,and from 3 days to 24 days after operation were(0.7±0.5)cm(P=0.010)and(1.0±0.7)cm(P=0.008)respectively,all of which were significantly lower than the reduction in the control group.Other characters were not significantly different between groups.Conclusion:Parenteral nutrition containing glutamine may decrease lean body mass loss in patients with HCVD during hospitalization.