谷氨酰胺双肽对老年腹部手术后患者内毒素血症及预后和卫生经济学的影响  

Effects of glutamine dipeptide on plasma endotoxin, outcome and health economy of elderly (post-abdominal) operation patients

作　　者：朱明炜[1] 唐大年[1] 韦军民[1] 赵旭[1] 叶国栋[1] 龙海空[1] 曹金铎[1] 

机构地区：[1]卫生部北京医院普外科,100730

出　　处：《中华老年医学杂志》2005年第8期585-588,共4页Chinese Journal of Geriatrics

摘　　要：目的评价谷氨酰胺双肽对老年腹部手术后患者内毒素血症、预后和卫生经济学的影响。方法采用前瞻、随机、双盲和对照的方法,41例老年择期腹部中等手术患者分为添加谷氨酰胺双肽的肠外营养组(Gln组,21例)和仅用18种复合氨基酸的肠外营养组(对照组,20例),两组患者具有可比性,术后进行6d等氮、等热卡的肠外营养;对血浆谷氨酰胺浓度、肠黏膜通透性、血浆内毒素水平、病死率、感染有关并发症、住院费用、术后住院日及安全性等方面进行观察。结果Gln组术后6d的血浆谷氨酰胺为(601±54)μmol/L,明显高于对照组的(435±73)μmol/L(P<0.05);术后7d,两组的肠黏膜通透性均增高,对照组的变化幅度为0.070±0.072,明显高于Gln组的0.035±0.061(P<0.05);术后1d,内毒素水平明显高于术前,随时间可逐渐下降,Gln组术后4d的内毒素水平明显低于对照组,两组比较差异有统计学意义(P<0.05)。未发生死亡事件;感染并发症,Gln组有3例,对照组5例;术后住院日和总住院费用两组相似;无不良事件。结论添加谷氨酰胺双肽的肠外营养能减轻老年创伤后患者肠黏膜屏障的损害和内毒素血症,可能减少感染并发症和术后住院日。Objective Evaluate the effects of glutamine dipeptide on plasma endotoxin（PE） level, outcome and health economy of elderly post-abdominal operation patients. Methods It was a prospective, randomized, double blind and control clinical trial. Forty one cases of elderly patients who were undergoing abdominal operation were divided into a group of parenteral nutrition with the given glutamine-dipeptide （Gin group, 21 cases ） and PN group （parental nutrition, 20 cases ）. The patients from 2 groups were gender and age-comparable and received the parenteral nutrition of isonitrogenous and isocaloric intake therapy for 6 days after operation. The plasma glutamine concentration, gut permeability, plasma endotoxin level, mortality, infectious complications,hospitalization cost , hospital stay of post-operation and safety were observcd. Results The plasma glutamine level was obviously higher （601 ± 54）μmol/L in Gln group on the 6^th post-operation day,than in parenteral nutrition group[（435 ± 73）μmol/L, P〈0.05]. The gut permeability was increased in both groups on the 7^th post-operation day, but the change of parenteral nutrition group was obviously higher （0. 070±0, 072） than that of the Gln group （0. 035±0. 061, P〈0. 05）. The level of PE was higher on the 1^st post-operation day than on the pre-operation day, while it decreased gradually. The PE level was lower in Gln group than in parenteral nutrition group on the 4^th post-operation day （P〈0.05）, In this trial, no patient was dead. The infectious complications were 3 cases in Gln group, but 5 in parenteral nutrition group. The similar post-operation stay and hospitalization cost and no adverse events were reported. Conclusions The parenteral nutrition therapy with the given glutamine-dipeptide can decrease the injury of gut permeability and endotoxemia, and probably decrease the infectious complications and post-operation hospital stay.

关 键 词：谷氨酰胺双肽 老年人 腹部手术 内毒素血症 预后 卫生经济学 

分 类 号：R656[医药卫生—外科学]