腹部大手术后使用谷氨酰胺二肽的全胃肠外营养：一项随机、双盲、对照研究
Total parenteral nutrition with glutamine dipeptide after major abdominal surgery: a randomized, double-blind, controlled study.
作者信息
Morlion B J, Stehle P, Wachtler P, Siedhoff H P, Köller M, König W, Fürst P, Puchstein C
机构信息
Department of Anesthesiology and Intensive Care Medicine, Marienhospital Herne, Ruhr-University of Bochum, Germany.
出版信息
Ann Surg. 1998 Feb;227(2):302-8. doi: 10.1097/00000658-199802000-00022.
OBJECTIVE
To assess the efficacy of glutamine (Gln) dipeptide-enriched total parenteral nutrition (TPN) on selected metabolic, immunologic, and clinical variables in surgical patients.
SUMMARY BACKGROUND DATA
Depletion of Gln stores might lead to severe clinical complications. Recent studies indicate that the parenteral provision of Gln or Gln-containing dipeptides improves nitrogen balance, maintains the intracellular Gln pool, preserves intestinal permeability and absorption, and shortens hospital stay.
METHODS
Twenty-eight patients (age range, 42-86 years, mean 68 years) undergoing elective abdominal surgery were allocated, after randomization, to two groups to receive isonitrogenous (0.24 g nitrogen kg(-1) day(-1)) and isoenergetic (29 kcal/122 kJ kg(-1) day(-1)) TPN over 5 days. Controls received 1.5 g of amino acids kg(-1) day(-1), and the test group received 1.2 g of amino acids and 0.3 g of L-alanyl-L-glutamine (Ala-Gln) kg(-1) day(-1). Venous heparinized blood samples were obtained before surgery and on days 1, 3, and 6 after surgery for routine clinical chemistry and for the measurement of plasma free amino acids. Lymphocytes were counted and the generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes was analyzed before surgery and on days 1 and 6 after surgery. Nitrogen balances were calculated postoperatively on days 2, 3, 4, and 5.
RESULTS
No side effects or complaints were noted. Patients receiving Gln dipeptide revealed improved nitrogen balances (cumulative balance over 5 days: -7.9 +/- 3.6 vs. -23.0 +/- 2.6 g nitrogen), improved lymphocyte recovery on day 6 (2.41 +/- 0.27 vs. 1.52 +/- 0.17 lymphocytes/nL) and improved generation of cysteinyl-leukotrienes from polymorphonuclear neutrophil granulocytes (25.7 +/- 4.89 vs. 5.03 +/- 3.11 ng/mL). Postoperative hospital stay was 6.2 days shorter in the dipeptide-supplemented group.
CONCLUSION
We confirm the beneficial effects of Gln dipeptide-supplemented TPN on nitrogen economy, maintenance of plasma Gln concentration, lymphocyte recovery, cysteinyl-leukotriene generation, and shortened hospital stay in surgical patients.
目的
评估富含谷氨酰胺（Gln）二肽的全胃肠外营养（TPN）对手术患者特定代谢、免疫及临床指标的疗效。
总结背景资料
Gln储备耗竭可能导致严重临床并发症。近期研究表明，胃肠外给予Gln或含Gln的二肽可改善氮平衡、维持细胞内Gln库、保持肠道通透性及吸收功能，并缩短住院时间。
方法
28例（年龄范围42 - 86岁，平均68岁）择期腹部手术患者，随机分组后，两组均接受5天等氮量（0.24 g氮·kg⁻¹·天⁻¹）和等能量（29 kcal/122 kJ·kg⁻¹·天⁻¹）的TPN。对照组接受1.5 g氨基酸·kg⁻¹·天⁻¹，试验组接受1.2 g氨基酸和0.3 g L - 丙氨酰 - L - 谷氨酰胺（Ala - Gln）·kg⁻¹·天⁻¹。术前及术后第1、3、6天采集静脉肝素化血样，用于常规临床化学检测及血浆游离氨基酸测定。术前及术后第1、6天进行淋巴细胞计数，并分析多形核中性粒细胞半胱氨酰白三烯的生成情况。术后第2、3、4、5天计算氮平衡。
结果
未观察到副作用或不良反应。接受Gln二肽的患者氮平衡改善（5天累积平衡：-7.9±3.6 vs. -23.0±2.6 g氮），第6天淋巴细胞恢复情况改善（2.41±0.27 vs. 1.52±0.17淋巴细胞/μL），多形核中性粒细胞半胱氨酰白三烯生成增加（25.7±4.89 vs. 5.03±3.11 ng/mL）。补充二肽组术后住院时间缩短6.2天。
结论
我们证实了补充Gln二肽TPN对手术患者氮代谢、血浆Gln浓度维持、淋巴细胞恢复、半胱氨酰白三烯生成及缩短住院时间具有有益作用。
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