肠外营养联合谷氨酰胺在普外科危重病人的应用

Application of glutamine-combined with parenteral nutrition in the critically ill patients of general surgery

目的研究谷氨酰胺(Gln)增强的肠外营养对普外科危重病人的影响。方法将40例符合SIRS诊断标准的普外科危重和大手术后病人随机分成Gln组和对照组,各20例,两组均于给予常规外科治疗,并于术后第1～3天后开始肠外营养连续7天,其中Gln组的氮量由20%L-丙氨酰-L-谷氨酰胺溶液供给(0.5g·kg-1·d-1),其余部分由7～11.4%氨基酸溶液供给。两组病人分别于肠外营养前和营养后7天抽取外周血测量血红蛋白(HB)、白蛋白(Alb)、转铁蛋白(TRF)、免疫球蛋白G(IgG)、A(IgA)、M(IgM)。并进行APACHEⅡ评分。结果Gln组经肠外营养治疗后IgG、TRF分别由9.2±3.1、1.17±0.3增高至14±2.8、1.36±0.7,相比差异显著(P<0.05),Gln组又较对照组评分下降(P<0.05)。结论Gln增强的肠外营养能改善普外科危重病人蛋白质代谢,提高机体免疫功能,减轻病情的危重程度。

Objective To investigate the effect of glutamine(Gln) in enhancing parenteral nutrition on critically ill patients in general surgery.Methods Fort y surgical patients with critieally ill were divided into Gln group and control group.All patients were treated with routine surgical treatment combined with pa renteral nutrition and observed for 7 days.20 case in Gln group were treated wit h Gln supplied by 20%L-Ala-Gln solution(Dosage:0 5 g·kg·d-1)and another 2 0 cases in control group without Gln.The data about Hb,Alb,TRF,IgG,IgM,IgA and s cores of acute physiology and chronic health evalution(APACHEⅡ)were analysed re trospectively.Results The level of IgG、TRF increased more after treatment(14±2 8、1 36±0 7)than before(9 2±3 1、1 17±0 3)in Gln group(P< 0 05).The score of APACHE Ⅱdecreased significantly in two groups(P< 0 05),and the decrea se in Gln group was more obvious than in control group(P< 0 05). Conclusion Gln-intensified parenteral nutrition can improve protein metabolism and immunofunc tion,help to resume the function of cells and organs,reduce the seveve degree of critically ill patients in general surgery.