谷氨酰胺颗粒对创伤患者肠黏膜屏障功能的影响  

Glutamine granules affect intestine mucosal barrier function in trauma patients

作　　者：彭曦[1] 尤忠义[1] 黄显凯[2] 张才全[3] 贺光照[4] 解伟光[5] 全竹富[6] 

机构地区：[1]第三军医大学附属西南医院烧伤研究所创伤,烧伤,复合伤国家重点实验室,重庆400038 [2]第三军医大学附属大坪医院野战外科研究所创伤中心 [3]重庆医科大学附属第一医院普通外科 [4]重庆医科大学附属第一医院烧伤科 [5]南京军区总医院烧伤科 [6]南京军区总医院普通外科

出　　处：《中华创伤杂志》2004年第7期424-427,共4页Chinese Journal of Trauma

摘　　要：目的　观察服用谷氨酰胺 (glutamine ,GLN)颗粒对创伤、烧伤及大手术患者肠黏膜屏障功能的影响及可能发生的不良反应。　方法　采用随机、双盲对照法 ,将受试患者分为谷氨酰胺组和安慰剂 (甘氨酸 )对照组 (P组 ) ,每组 6 0例 ,两组患者采用等氮、等热卡的营养支持。谷氨酰胺组口服或管饲谷氨酰胺 0 .5g·kg-1·d-1,P组使用同等剂量的安慰剂 ,疗程为 7d。比较各组患者用药前后血浆谷氨酰胺浓度、肠黏膜屏障功能、肝、肾功能及不良反应发生率。　结果　用药前两组患者血浆谷氨酰胺浓度明显低于正常值 ,肠黏膜通透性明显增高。与P组相比 ,谷氨酰胺组患者用药 7d后血浆谷氨酰胺浓度 [(5 92 .5 0± 185 .2 3) μmol/L]明显高于P组 [(4 0 7.4 1± 190 .2 2 )μmol/L) ],增幅达4 5 .4 % (P <0 .0 1)。谷氨酰胺组患者肠黏膜通透性明显改善 ,血浆二胺氧化酶(DAO)活性 [(1.2 2± 0 .4 5 )U/ml]、内毒素含量 [(0 .2 1± 0 .0 9)U/ml]、乳果糖 /甘露醇比值 (0 .11± 0 .0 7)明显低于P组 [分别为 (2 .2 7± 1.90 )U/ml、(0 .2 7± 0 .0 9)U/ml和 0 .2 3± 0 .13],降幅分别为 4 6 .3%、2 2 .2 %和 5 2 .2 % (P <0 .0 5～ 0 .0 1)。血、尿常规及肝、肾功能两组之间差异无显著性意义 (P >0 .0 5 )。Objective To evaluate the protective effect of glutamine granules on intestine mucosal barrier function in burn and trauma patients as well as in surgically treated patients and operative patients and explore the possible adverse effect. Methods A total of 120 patients with severe burns and multiple trauma were randomly and equally divided into placebo control group (Group P) and glutamine granules treatment group (Group GLN) through random and double-blind trails. Equal isonitrogenous and isocaloric intakes were performed in both groups. Glutamine granules at 0.5 g/kg was given in the Group GLN and equal dosage of placebo (glycine) given in the Group P. The whole treatment lasted for seven days. The concentration of plasma glutamine,the intestinal mucosal barrier function,the functions of the livers and the kidneys as well as the adverse effect were observed and compared in both groups before and after treatment. Results Before treatment,the plasma glutamine concentration in both groups was significantly lower than the normal level, with increased intestinal mucosal permeability. However,seven days after oral intake of glutamine granules,plasma glutamine concentration in the Group GLN was increased by 45.4%,reached (592.50±185.23) μmol/L,which was significantly higher than (407.41±190.22) μmol/L in the Group P ( P <0.01). On the other hand,the activity of plasma diamine oxidase (DAO),the endotoxin level and the urinary L/M ratio were (1.22±0.45) U/ml,( 0.21 ±0.09) U/ml and (0.11±0.07),respectively in the Group GLN,lower than (2.27± 1.90) U/ml ,(0.27±0.09)U/ml and 0.23±0.13,respectively in the Group P,with decrease rates of 46.3%, 22.2% and 52.2% respectively ( P <0.05-0.01). There was no significant difference upon urinary hematuria and functions of the livers and the kidneys ( P >0.05). In addition,the slight side effect including nausea,diarrhea and constipation occurred in seldom cases,with insignificant difference between both groups ( P >0.05). Conclusions Glutamine granules can increase plasma

关 键 词：谷氨酰胺颗粒 创伤 肠黏膜 屏障功能 GLN 烧伤 肾功能 

分 类 号：R641[医药卫生—外科学]