丙氨酰谷氨酰胺强化全胃肠外营养在胰腺癌部分切除术后患者中应用的回顾性病例研究

Application of alanyl glutamine enriched total parenteral nutrition in patients with pancreatic cancer after partial resection:a retrospective case study

目的:探讨丙氨酰谷氨酰胺强化全胃肠外营养在胰腺癌部分切除术后患者中应用的效果。方法:回顾性分析2014年1月至2018年12月某院收治的胰腺癌部分切除术后患者136例。术后营养支持只使用全胃肠外营养的为对照组(n=64),使用丙氨酰谷氨酰胺强化全胃肠外营养的为强化组(n=72)。比较2组患者空腹血糖、胰岛素用量;血清淀粉酶(AMY)、血清脂肪酶(LIPA)、AMY异常率(AMYAR)、LIPA异常率(LIPAAR);脂肪泻、腹胀、腹痛、胰腺外分泌功能不全的发生率,肠外营养相关肝病等安全性指标及总住院时长等临床结局指标。结果:(1)血糖控制水平比较:术后3 d空腹血糖、胰岛素使用量比较无统计学意义(P>0.05);术后7 d、12 d强化组低于对照组(P<0.05)。(2)胰腺外分泌酶比较:术后3 d的AMY、LIPA、AMYAR、LIPAAR比较无统计学意义(P>0.05);术后7 d、12 d强化组AMY、LIPA高于对照组(P<0.05),强化组AMYAR、LIPAAR低于对照组(P<0.05)。(3)安全性比较:脂肪泻发生率强化组低于对照组(P<0.05),胰腺外分泌功能不全、腹痛、腹胀、导管性脓毒症、肠外营养相关肝病和再喂养综合征发生率比较无统计学意义(P>0.05)。(4)临床结局指标比较:总住院时长、总住院费用、在院病死率比较无统计学意义(P>0.05)。结论:丙氨酰谷氨酰胺强化全胃肠外营养有利于改善因胰腺癌部分切除而导致的血糖紊乱,降低血糖,减少胰岛素用量,升高胰腺外分泌酶AMY、LIPA,减少AMY、LIPA低于正常值的发生率,减少脂肪泻发生,使用安全有效。但不能明显缩短住院时间,降低住院费用和病死率。

OBJECTIVE To explore the effect of alanyl glutamine enriched total parenteral nutrition in patients with pancreatic cancer after partial resection.METHODS Retrospective analysis was performed for pancreatic cancer from January 2014 to December 2018.A total of 136 patients fulfilling the selection criteria were divided into two groups of intensive(n=72)and control(n=64).The control group received routine total parenteral nutrition alone and intensive group had an addition of alanyl glutamine.Fasting blood glucose,dosage of insulin,AMY,LIPA,AMYAR,LIPAAR,safety parameters of steatorrhea,abdominal distension,abdominal pain,exocrine pancreatic insufficiency,parenteral nutrition related liver disease and clinical outcome parameter of total length of stay were compared between two groups.RESULTS Comparison of control level of blood glucose:fasting blood glucose and dosage of insulin were markedly lower in intensive group than those in control group at Days 7 and 12 post-operation(P<0.05).Comparison of digestive enzymes:AMY and LIPA were significantly higher in intensive group than those in control group at Days 7 and 12 post-operation(P<0.05);AMYAR and LIPAAR were lower in intensive group than those in control group(P<0.05).Comparison of safety:the incidence of steatorrhea was lower in intensive group than that in control group(P<0.05),no significant difference existed in the incidence of exocrine pancreatic insufficiency,abdominal pain,abdominal distension,catheter sepsis,parenteral nutrition related liver disease or refeeding syndrome(P>0.05).Comparison of clinical outcome parameters:no inter-group difference existed in hospital stay,total hospitalization cost or in-hospital mortality(P>0.05).CONCLUSION Alanyl glutamine enhanced total parenteral nutrition can improve blood glucose disorder caused by partial pancreatectomy,reduce blood glucose and insulin dosage.In addition,it can elevate the pancreatic exocrine enzymes AMY and LIPA,lower the incidence of lower values of AMY and LIPA and reduce the incidence of steatorrhea.Its application is both safe and effective.However,it fails to significantly shorten the length of hospital stay and lower hospital costs and mortality.