Souba W W, Klimberg V S, Plumley D A, Salloum R M, Flynn T C, Bland K I, Copeland E M
Department of Surgery, University of Florida College of Medicine, Gainesville 32610.
J Surg Res. 1990 Apr;48(4):383-91. doi: 10.1016/0022-4804(90)90080-l.
In the critically ill surgical patient a variety of therapeutic maneuvers is required to maintain a "healthy gut." Provision of adequate amounts of glutamine to the gastrointestinal mucosa appears to be just one of these maneuvers. Other methods utilized to protect the gut from becoming a wound include: (a) minimizing additional systemic insults (such as hypotension, sepsis, multiple operative procedures); (b) aggressive pulmonary care; (c) the judicious use of antibiotics; and (d) aggressive enteral or parenteral feedings. The concept that the gut is an organ of quiescence following surgical stress merits reconsideration. The intestinal tract plays a central role in interorgan glutamine metabolism and is a key regulator of nitrogen handling following surgical stress. Critically ill patients are susceptible to developing gut-origin sepsis, the incidence of which will be diminished by instituting measures and providing treatments which support intestinal structure, function, and metabolism. Provision of glutamine-enriched diets to such patients may be one of these therapies.
对于重症外科患者，需要采取多种治疗措施来维持“健康的肠道”。向胃肠道黏膜提供充足的谷氨酰胺似乎只是其中一项措施。用于保护肠道不成为伤口来源的其他方法包括：(a)尽量减少额外的全身性损伤（如低血压、脓毒症、多次手术）；(b)积极的肺部护理；(c)谨慎使用抗生素；以及(d)积极的肠内或肠外营养支持。认为肠道在手术应激后处于静止状态的观念值得重新审视。肠道在器官间谷氨酰胺代谢中起核心作用，并且是手术应激后氮处理的关键调节者。重症患者易发生肠道源性脓毒症，通过采取支持肠道结构、功能和代谢的措施及提供相应治疗，其发生率会降低。为这类患者提供富含谷氨酰胺的饮食可能是这些治疗方法之一。
