大手术后免疫增强型肠内营养对血浆内毒素水平、血浆灭活内毒素能力和预后的影响  

Effects of postoperative enteral immune-enhancing nutrients on plasma endotoxin level, plasma endotoxin inactivation capacity and clinical prognosis

作　　者：姚国相[1] 薛新波[1] 卢兴培[1] 王剑明[1] 王欣[1] 俞亚红[1] 朱峰[1] 姜立[1] 申铭[1] 丁志强[1] 秦仁义[1] 邹声泉[1] 钱家勤[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院外科,湖北省武汉市430030

出　　处：《世界华人消化杂志》2005年第16期1992-1995,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨含谷氨酰胺、精氨酸、ω-3多不饱和脂肪酸等特殊营养物质的免疫增强型肠内营养制剂对大手术后血浆内毒素水平、血浆灭活内毒素能力和预后的影响.方法:腹部大手术患者40例,随机分为普通肠内营养组(对照组)和特殊肠内营养组(研究组).手术后1d开始给予等热量、等含氮量的肠内营养支持1wk.于手术前、术后1d和研究结束时,分别检测血浆内毒素、血浆灭活内毒素能力并评价术后感染相关性并发症和术后住院日.结果:两组之间的血浆内毒素水平及感染相关性并发症没有显著性的差异.血浆灭活内毒素能力在手术后呈显著性下降;研究组血浆灭活内毒素能力在术后4d早晨较对照组有显著的恢复(对照组0.12±0.02kEU/Lvs研究组0.068±0.022kEU/L,P<0.01).研究组术后住院日较对照组有缩短(对照组12.3±1.6vs研究组10.9±17,P<0.05)结论:含特殊营养物质的免疫增强型肠内营养能改善手术后的免疫抑制,对术后的内毒素血症没有影响.AIM： To investigate the effects of immune-enhancing nutrients such as glutamine, arginine and ω-3-fatty acid on the plasma endotoxin, plasma sCD14, plasma endotoxin inactivation capacity and clinical prognosis of patients received gastrointestinal operations. METHODS： Forty patients received gastrointestinal opera- tions were randomly divided into two groups （20 for each）. One group received standard enteral nutrition and the other was fed the standard formulation supplemented with glutamine, arginine and ω-3-fatty acid, One day after the operation, the patients were administered with the above nutrients that contained equal energy and equal amount of nitrogen for 7 days. Blood samples were collected 1 day before the operation and 1, 4 and 7 days after the operation for the detection of plasma endotoxin level and endot-oxin inactivation capacity （EIC）. The infection-associated complications and the prognosis were also evaluated. RESULTS： There were no significant differences between the two groups in plasma endotoxin levels and the infection-associated complications. After the operation, a rapid reduction in plasma endotoxin inactivation capacity was observed in both groups, but a significant restoration the plasma endotoxin inactivation capacity was observed 4 days after the operation in the study group （0.12 ± 0.02 kEU/L and 0.078±0.022 kEU/L for the control and study group, respectively, P〈0.01 ）. Shortened hospital stay was observed in the study group （11.7 ± 2.0 and 10.6 ± 1.2 days in the control study group, respectively, P〈0.05）. CONCLUSION： Perioperative parenteral nutrition supplemented with immune-enhancing nutrients can ameliorate the postoperative immunodepression, but it has no significant effect on endotoxemia.

关 键 词：胃肠道手术 免疫增强型肠营养 内毒素 内毒素灭活 预后 免疫增强型肠内营养 血浆内毒素 内毒素水平 手术后 能力 

分 类 号：R619[医药卫生—外科学]