Asprer Jonathan M, Llido Luisito O, Sinamban Reynaldo, Schlotzer Ewald, Kulkarni Hrishikesh
St Lukes Medical Center, Clinical Nutrition, Obesity, and Weight Management Center, Philippines.
Nutrition. 2009 Sep;25(9):920-5. doi: 10.1016/j.nut.2009.01.014.
To determine if parenteral glutamine dipeptide supplementation given only in the preoperative period in malnourished patients after gastrointestinal surgery would sustain its effects into the first postoperative week, as shown by immune indices.
A prospective randomized study on malnourished adult patients for abdominal surgery was done where one group (n = 17) received preoperative glutamine supplementation (0.3 g . kg(-1) x d(-1)) for 5 d and the other (n = 17) had none. Both received isocaloric (30 kcal x kg(-1) x d(-1)) and isonitrogenous (1.5 g x kg(-1) x d(-1)) nutrition. Outcomes were 1) immune indices on admission (day 1), the day before surgery (day 2), and the seventh postoperative day (day 3); and 2) clinical outcomes were infection, wound complication, days in the intensive care unit, and mortality. Statistical tests were repeated samples analysis of variance, Friedman's test, Wilcoxon's test, and t test for individual comparison.
The glutamine-supplemented group showed an increase in total white blood cells (from 8700 on day to 11 080 on day 2, P = 0.026), granulocytes (from 6177 on day 1 to 8568 on day 2, P = 0.039), and lymphocytes (from 1516 on day 1 to 1747 on day 2, P = 0.049). Significant decreases in glutamine-supplemented group values from day 2 to day 3 occurred in granulocytes, lymphocytes, and CD8, CD22, and CD19 cells. Clinical outcome was similar in both groups. Intake was adequate in both groups (preoperative 85% versus postoperative 82% computed) and the mean glutamine delivered was 18 g/d.
Parenteral glutamine supplementation in the preoperative period resulted in increased white blood cell, granulocyte, and lymphocyte counts, which was not sustained in the first week of the postoperative period, when supplementation was discontinued before surgery.
确定胃肠道手术后营养不良患者仅在术前给予肠外谷氨酰胺二肽补充剂是否能像免疫指标所示的那样，使其效果持续到术后第一周。
对成年腹部手术营养不良患者进行了一项前瞻性随机研究，一组（n = 17）术前补充谷氨酰胺（0.3 g·kg⁻¹·d⁻¹），共5天，另一组（n = 17）不补充。两组均接受等热量（30 kcal·kg⁻¹·d⁻¹）和等氮量（1.5 g·kg⁻¹·d⁻¹）营养。观察指标为：1）入院时（第1天）、手术前一天（第2天）和术后第七天（第3天）的免疫指标；2）临床结局为感染、伤口并发症、重症监护病房住院天数和死亡率。统计检验采用重复样本方差分析、Friedman检验、Wilcoxon检验和t检验进行个体比较。
补充谷氨酰胺组总白细胞（从第1天的8700升至第2天的11080，P = 0.026）、粒细胞（从第1天的6177升至第2天的8568，P = 0.039）和淋巴细胞（从第1天的1516升至第2天的1747，P = 0.049）均有所增加。从第2天到第3天，补充谷氨酰胺组的粒细胞、淋巴细胞以及CD8、CD22和CD19细胞值显著下降。两组临床结局相似。两组摄入量均充足（术前计算为85%，术后为82%），平均给予的谷氨酰胺为18 g/d。
术前肠外补充谷氨酰胺可导致白细胞、粒细胞和淋巴细胞计数增加，但在术后第一周当术前停止补充时，这种增加未能持续。
