谷氨酰胺颗粒对创伤患者蛋白代谢的影响

Effects of glutamine granules on protein metabolism in trauma patients

目的 观察服用谷氨酰胺颗粒对创伤、烧伤及大手术患者蛋白代谢的影响及可能发生的不良反应。方法 采用随机、双盲对照法 ,将受试患者分为谷氨酰胺 (glutamine,GLN)组和安慰剂对照(placebo,P)组 ,每组 6 0例 ,两组患者采用等氮、等热卡的营养支持。GLN组口服或管饲GLN 0 5 g·kg-1·d-1,对照组使用同等剂量的安慰剂 (甘氨酸 ) ,疗程为 7d。比较各组患者血浆GLN浓度、蛋白代谢、肝肾功能及不良反应发生率 ,对烧伤患者还观察了创面愈合情况和住院时间。结果两组患者血浆GLN浓度、血浆蛋白含量均明显低于正常值 ,而尿氮排量则明显增高。两组比较 ,GLN组患者使用谷氨酰胺颗粒 7d后血浆GLN浓度明显增高 (5 92 5 0± 185 2 3μmol/Lvs.4 0 7 4 1± 190 2 2 μmol/L) ,增幅达4 5 4 3% (P <0 0 1)。与之对应 ,血浆前白蛋白 (0 2 9± 0 10 g/Lvs.0 2 4± 0 0 7g/L)、转铁蛋白 (5 4 4±3 0 3g/Lvs.3 6 0± 2 0 2 g/L)含量均显著高于P组 ,升幅分别为 2 0 83%、5 1 11% (P <0 0 1) ,而尿氮排量则明显低于P组 (6 78± 4 78g/dvs.9 38± 6 0 2g/d) ,降幅为 2 7 78% (P <0 0 1)。血浆总蛋白、白蛋白含量、血尿常规及肝肾功能两组差异无显著意义 (P >0 0 5 )。少数患者出现轻微不良反应 ,如恶心。

Objective To evaluate the effect of glutamine granules on protein metabolism in severe burns and trauma patients. Methods 120 patients with severe burns, multiple trauma and post operation who met the requirements of the protocol joined this double-blind randomized controlled, multi-center clinical trail. Patients were randomly divided into two groups: placebo control group(P group, 60 patients) and glutamine granules treatment group (GLN group, 60 patients). There was isonitrogenous and isocaloric intake in both groups, GLN and P group patents had been given glutamine granules or placebo (glycine) at 0.5 g·kg -1·d -1 for 7 days, respectively. The level of plasma glutamine, protein and urine nitrogen exclude were determined, wound healing rate of burn area and hospital stay were recorded, and then observed the complication and side effect. Results After 7 days of taking glutamine granules orally, plasma GLN concentration was significant higher than that in P group(592.50±185.23 μmol/L vs. 407.41±190.22 μmol/L)(P<0.01). Plasma prealbumin and transferrin in GLN group were significant higher than those in P group (P<0.01), but the concentration of total protein and albumin were no marked changes compare with P group (P>0.05). The capacity of urine nitrogen exclude in GLN group were significant lower than that in P group. Additional, the wound healing rate was faster and hospital stay days was shorter than P group (P<0.05), and the occurrence of glutamine granules side effect was seldom. Conclusion Taking glutamine could promote protein synthesis,abate protein decompose, ameliorate wound healing rate and reduce hospital stay obviously.