谷氨酰胺治疗肠梗阻的疗效分析

谷氨酰胺治疗肠梗阻的疗效分析
李颖;崔夕军;吴俊伟;卢壁辉;黄壮生
【期刊名称】《中国现代普通外科进展》
【年(卷),期】2011(14)4
【摘要】目的:谷氨酰胺(Gln)对肠梗阻肠黏膜通透性及细菌移位的影响.方法:将80例肠梗阻患者随机分为对照组和治疗组.对照组给予禁食、胃肠减压、纠正水电解
质和酸碱平衡紊乱,全胃肠外营养以及抗生素等常规治疗;治疗组在常规治疗基础上,全胃肠外营养液中加用Gln.比较两组患者入院时、治疗5 d、治疗10 d的常规指
标(体质量、血糖、血清白蛋白、血清前白蛋白、血清转铁蛋白)、免疫学指标(CRP、外周血白细胞计数、IgA、IgM、IgG、TNF-a、IL-6)和肠黏膜通透性评价指标[外周血浆Gln浓度、尿乳果糖甘露醇比值(L/M)、外周血细菌DNA阳性率].结果:治
疗后两组血清白蛋白、血清前白蛋白、血清转铁蛋白显著升高(P<0.05);血糖明显
降低(P<0.05).对照组治疗10 d IgA较治疗5 d明显降低(P<0.05);治疗组无明显
变化.治疗后治疗组血浆Gln浓度高于对照组(P<0.01),治疗组治疗1 0 d尿L/M、外周血细菌DNA阳性率低于对照组(P(0.01).结论:肠梗阻患者应用Gln有助于维护肠黏膜屏障功能、减少细菌移位.%Objective: To investigate the relationship between changes in intestinal permeability and bacterial translocation in patients with intestinal obstruction; and to explore the effect of glutamine on intestinal permeability and bacterial translocation. Methods: 80 patients with different types of intestinal obstruction were randomly divided into treatment group and control group. Control group received conventional treatment, including fasting, gastrointestinal decompression, correcting
water electrolyte and acid-base balance lisorders, total parenteral nutrition and antibiotics; treatment group used glutamine on the basis of conventional therapy. Peripheral blood of patients in the two groups were collected for Phthalocyanine amine plasma glutamate concentration and detection of bacterial DNA in whole blood,meanwhile,we measured urinary lactulose / mannitol(L/M) ratio, and statistical analysis was performed on the above indexes. Results: Serum albumin, serum prealbumin, serum transferrin in both groups increased higher significantly (P＜0.05) while blood glucose was obviously lower (P＜0.05). In the control group, IgA of the late course decreased sharply than the earlier (P＜0.05), but there was no significant change in the treatment group. Complications, infection rate, mortality, hospital stay and treatment costs in the treatment group were
all lower than the control group (P＜0.05). Plasma glutamine concentrations in the treatment group was higher (P＜0.01) than the control group ,but the urinary lactulose / mannitol (L/M) ratio in the late course and the positive rate of bacterial DNA in peripheral blood (P＜0.01). Conclusion: Glutamine plays an important role in maintaining gut barrier function in patients with intestinal obstruction, at the same time ,it can reduce bacterial translocation and complications.
【总页数】4页(P277-280)
【作者】李颖;崔夕军;吴俊伟;卢壁辉;黄壮生
【作者单位】广东省汕头市中心医院,外二科,广东,汕头,515000;山东省威海市文登中心医院,普外一科,山东威海264200;广东省汕头市中心医院,外二科,广东,汕
头,515000;广东省汕头市中心医院,外二科,广东,汕头,515000;广东省汕头市中心医院,外二科,广东,汕头,515000
【正文语种】中文
【中图分类】R574.2
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