恶性肿瘤术后危重患者早期肠内应用谷氨酰胺的作用  

Effects of postoperative early glutamine supplemented enteral nutrition on the treatment of critically ill patients after the digestive tract cancer radical operation

作　　者：杨奕[1] 李青[1] 王宏志[1] 任宏[1] 杨乃众[1] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院,北京市肿瘤防治研究所ICU,100036

出　　处：《临床麻醉学杂志》2008年第3期244-246,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨术后肠内早期应用谷氨酰胺对消化道恶性肿瘤根治手术后的危重患者营养状态、免疫功能和临床治疗的影响。方法采用前瞻、随机、对照的方法,将重症监护室(ICU)132例行食管癌或胃癌根治术后危重患者分为两组:谷氨酰胺组(Gln组,n=70)给予标准的与对照组(n=62)等氮量、等热量营养支持,并于术后24h开始肠内给予谷氨酰胺;对照组仅给予标准营养支持治疗。两组患者均于治疗前及治疗后7d分别取外周血测定血清白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TRF)、免疫球蛋白IgG、IgA、IgM;采用流式细胞分析仪测定淋巴细胞亚群CD3+、CD4+、CD4+/CD8+的变化,并测量治疗前后的体重变化。观察急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化、ICU住院时间、术后感染性并发症发生率和28d病死率的情况。结果与对照组比较,治疗后7dGln组血清PAB、TRF和IgG的水平均明显增高(P<0·01),外周血淋巴细胞CD3+、CD4+、CD4+/CD8+表达水平均明显提高(P<0·01);APACHEⅡ评分较对照组明显下降(P<0·01),ICU住院时间缩短、术后感染的发生率减少(P<0·05),28d病死率稍有降低。结论术后早期肠内应用谷氨酰胺能促进消化道恶性肿瘤根治手术的危重患者的蛋白合成,改善营养状况,提高免疫功能,改善临床治疗结果。Objective To evaluate the effects of postoperative early glutamine supplemented enteral nutrition on the treatment of critically ill elderly patients after the digestive tract cancer radical operation. Methods A randomized and controlled clinical study was carried out in 132 critically ill aged patients underwent digestive tract cancer radical operation in intensive care unit（ICU）. The patients were randomly divided into two groups. Gln group was given standard nutrition support plus enteral Gln 30 g/d,and control group standard nutrition support. Blood samples before and 7 days after treatment were collected for analysis of serum proteins including albumin （ALB）, pre-albumin （PAB） ,transferrin （TRF）. Meanwhile, the variables including the level of IgG, IgA, IgM and T cell subsets were measured. The changes in acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, the ICU stay, postoperative infection rate and 28-day mortality were recorded. Results Compared with control group,the levels of serum PAB,TRF and IgG were significantly elevated and the T cell subsets were markedly higher （P〈0.01） ,and the APACHEⅡ ,the ICU stay ,postoperative infection rate were all reduced significantly in Gln group （P〈 0.05 or P〈 0. 01）, with 28-day mortality were decreased but not significantly different compared with control group （P〈0.05）. Conclusion The present findings indicate postoperative early glutamine supplemented enteral nutrition can improve nutritional condition and immune function, reduce the duration of ICU stay and the postoperative infection complications in the critically ill elderly patients after digestive tract cancer radical operation.

关 键 词：谷氨酰胺 消化系统肿瘤 根治手术 危重病 

分 类 号：R730.5[医药卫生—肿瘤]