腹部外科手术病人应用丙氨酰-谷氨酰胺双肽的临床意义  

The clinical importance of alanyl glutamine administration in patients undergoing abdominal operation

作　　者：曲军[1] 祝学光[1] 顾晋[1] 赵永东[1] 程锡魁[1] 王新会[1] 赵华[1] 于永祥[1] 

机构地区：[1]北京医科大学人民医院普通外科

出　　处：《中华普通外科杂志》1999年第3期213-215,共3页Chinese Journal of General Surgery

摘　　要：目的探讨丙氨酰谷氨酰胺（ＡｌａＧｌｎ）双肽对腹部外科手术后病人肠粘膜通透性及氮平衡的影响。方法观察３０例接受腹部外科手术的病人血浆谷氨酰胺（Ｇｌｎ）浓度的变化、尿乳果糖／甘露醇比率（Ｌ／Ｍ）的变化，以及氮平衡的情况，其中实验组１５例术后连续６天给予含ＡｌａＧｌｎ双肽的全胃肠外营养，对照组１５例给予传统的不含Ｇｌｎ的全胃肠外营养。结果经计量资料配对ｔ检验，１５例实验组连续６天给予添加ＡｌａＧｌｎ双肽的全胃肠外营养后第７天测定的血浆Ｇｌｎ浓度为（６１９±１４３）μｍｏｌ／Ｌ，明显高于术前测定值（５１５±９９）μｍｏｌ／Ｌ（Ｐ＜００１）和对照组（５２７±１１２）μｍｏｌ／Ｌ（Ｐ＜００５）；实验组尿Ｌ／Ｍ比率在术前（００５±００６）及术后第７天（００９±００４）变化不显著（Ｐ＞００５），而对照组于手术后尿Ｌ／Ｍ比率明显升高（术前００３±００２，术后００９±００６，Ｐ＜００５）；并且应用添加ＡｌａＧｌｎ双肽的全胃肠外营养后实验组于术后第４天即转为正氮平衡，对照组则始终处于负氮平衡。结论添加ＡｌａＧｌｎ双肽的全胃肠外营养能有效地补充机体的Ｇｌｎ缺乏，维持肠粘膜通透性，改善腹部外科手术?Objective To investigate the impact on intestinal mucosal permeability and nitrogen balance by the administration of alanyl glutamine dipeptide(Ala Gln). Methods The plasma glutamine concentration, the ratio of lactulose and mannitol excreted in urine (urine L/M ratio ) and nitrogen balance were observed in 30 patients undertaking abdominal operation, which include 15 patients in study group who were given Ala Gln supplemented total parenteral nutrition, and 15 patients in control group who were given traditional TPN with no glutamine (Gln) supply. Results Paired test of measurement data was used.In study group, after the Ala Gln supplemented TPN for 6 consecutive days, the plasma Gln concentration of 15 cases was measured on the 7th day. The result is (619±143) μmol/L, which is significantly higher than the preoperative value (515±99) μmol/L( P <0 01) and the control value (527±112) μmol/L( P <0 05). In study group, the urine L/M ratio measured on the 7th day after operation (0 09±0 04) was not significantly altered compared with that measured properatively (0 05±0 06)( P >0 05). However, the postoperative urine L/M ratio in control group was significantly elevated(preoperative value 0 03±0 02, postoperative value 0 09±0 06, P <0 05). In study group with Ala Gln supplemented TPN, the nitrogen balance become positive from the 4th day after operation, while in control group the nitrogen balance still remains negative. Conclusions Ala Gln supplemented TPN can correct body glutamine deficiency effectively, as well as maintain intestinal mucosal permeability, and improve nitrogen balance in abdominal operation patients.

关 键 词：腹部外科 双肽 丙氨酰 谷氨酰胺 通透性 

分 类 号：R656[医药卫生—外科学]