Petersson B, Waller S O, Vinnars E, Wernerman J
Department of Anesthesiology and Intensive Care, Karolinska Institute, St. Göran's Hospital, Stockholm, Sweden.
JPEN J Parenter Enteral Nutr. 1994 Jul-Aug;18(4):320-5. doi: 10.1177/014860719401800407.
In order to evaluate the long-term effect of total parenteral nutrition supplemented with glutamine after surgery, patients (n = 17) undergoing elective abdominal surgery were randomized into two groups and studied for 30 days after surgery. During the 3 days immediately after surgery, one group (n = 8) was given total parenteral nutrition including a conventional amino acid solution (control group). The other group (n = 9) was given isocaloric and isonitrogenous total parenteral nutrition including the same amino acid solution supplemented with the dipeptide, glycyl-glutamine (GLN group). Oral food intake started on the third postoperative day and was gradually increased at will. The concentration of free amino acids in percutaneous muscle biopsy specimens was determined preoperatively and on days 3, 10, 20, and 30 after the operation. Free glutamine decreased in skeletal muscle in the control group on days 3 and 10 by 32.2 +/- 5.4% (p < .01) and 20.1 +/- 6.9% (p < .05), respectively. In the glycyl-glutamine group, the decrease in glutamine was delayed until day 10 when it was 22.1 +/- 8.1% (p < .05). The glutamine levels were restored on days 20 and 30 in both groups. Total parenteral nutrition supplemented with glutamine maintained the free glutamine levels in skeletal muscle after surgery, but when treatment was discontinued, the glutamine concentration in muscle dropped, despite a normal enteral dietary intake.
为了评估术后补充谷氨酰胺的全胃肠外营养的长期效果，将接受择期腹部手术的患者（n = 17）随机分为两组，并在术后进行30天的研究。在术后立即的3天内，一组（n = 8）给予包括传统氨基酸溶液的全胃肠外营养（对照组）。另一组（n = 9）给予等热量和等氮量的全胃肠外营养，包括相同的氨基酸溶液并补充二肽甘氨酰 - 谷氨酰胺（GLN组）。术后第3天开始经口进食，并随意逐渐增加。在术前以及术后第3、10、20和30天测定经皮肌肉活检标本中游离氨基酸的浓度。对照组骨骼肌中的游离谷氨酰胺在第3天和第10天分别下降了32.2±5.4%（p <.01）和20.1±6.9%（p <.05）。在甘氨酰 - 谷氨酰胺组中，谷氨酰胺的下降延迟至第10天，此时下降了22.1±8.1%（p <.05）。两组在第20天和第30天谷氨酰胺水平均恢复。补充谷氨酰胺的全胃肠外营养在术后维持了骨骼肌中的游离谷氨酰胺水平，但当停止治疗时，尽管肠内饮食摄入正常，肌肉中的谷氨酰胺浓度仍会下降。
