谷氨酰胺双肽改善重度烧伤患者肠粘膜通透性的研究  被引量:19

Glutamine dipeptide enriched enteral nutrition improving gut permeability in sever burns

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作  者:周业平[1] 蒋朱明[2] 孙永华[1] 刘卫[2] 刘跃武[2] 舒红[2] 李德敏[2] 

机构地区:[1]北京积水潭医院烧伤科,100035 [2]中国医学科学院北京协和医院外科

出  处:《中华医学杂志》1999年第11期825-827,共3页National Medical Journal of China

基  金:卫生部重点科技基金!97010204

摘  要:目的观察严重烧伤后肠粘膜通透性的变化,研究谷氨酰胺双肽强化的肠内营养对重度烧伤患者肠粘膜通透性的影响。方法选择24例烧伤总面积大于30%,Ⅲ度面积大于20%的患者加入研究,随机分为对照组,给予安素和谷氨酰胺强化肠内营养组(GLN),每组12例。伤后6小时内开始接受肠内营养液,两组营养供应是等氮等热卡的。GLN组在基本肠内营养液中加入粉剂谷氨酰胺双肽每天0.5g/kg(相当于谷氨酰胺每天0.3g/kg)。监测伤后1、12天血清氨基酸谱,用特殊的高压液相色谱仪(Hplc-PED)检测伤后1、3、6、12天尿中乳果糖和甘露醇排出率比率,记录伤后30天创面愈合率及住院日,资料进行统计分析。结果伤后第1天2组血浆谷氨酰胺含量均显著低于正常值对照组:(361±71)μmol/L,GLN组:(349±53)μmol/L,P>0.05,正常值:(660±35)μmol/L,伤后第12天GLN组恢复正常,显著高于对照组[对照组:(418±75)μmol/L,GLN组:(566±128)μmol/L,P<0.01]。2组第1天L/M值显著升高(对照组:0.221±0.169,GLN组:0.268±0.202,P>0.05),而GLN组从伤后第3天L/M值降至接近正常,显著优于对照组(对照组:0.049±0.016,GLN组:0.025±0.008,P<0.01)。GLN组伤后30天创面愈合率及?Objective To determine the effect of glutamine dipeptide on gut permeability in severe burns. Methods Twenty-four severe burn patients were randomly divided into two groups: control group and GLN group. All patients received enteral nutrition for 12 days ther burn. Both groups were isocaloric and isonitrogen.GLN group patients were given nutrition solution enriched with glutamine dipeptide at a dosage at 0.5 g·kg(01)day(-1)(equivalent to L-glutamine 0.3 mg·kg(-1)·day(-1) ). On the day 1 and 12 after burn, the plasma amino acidwas measured by a standard dmino acid analyzer. On the day 1, 3, 6 and 12, the gut permeability was detected with Lactulose and Manitol assay by HPLC-PED, and then wound healing rate of burn area was determined on the day 30 and hospital stay was recorded. ANOVA was done for data analysis. Results the The plasma GLN concentrations decreased in both groups on day 1, (control group: 361.3 ±70.8 μm/L, GLN group: 348.6±52.5μm/L, P = 0.624, normal value: 659.5±35.0 μm/), and the GLN group showed high plasma GLN concentration on day 12 (566.4 ±128.3μm/L), with significant difference between control group (417.6±74.8μm/L, P = 0.002). On day 1, L/M ratio value was the highes in hath groups. On day 3, L/M ratio in the GLN group became lower than that of control group, and returned to normal on day 6 and maintained to day 12.There were significant differences of wound healing rate between the two groups and the length of hospital stay on day 30 (Control group: (81±7)%, GLN group: (89±7)%, 0.018) (Control group: 68±27 days, GLN group: 49±13 days, P = 0.049). Conclusion The glutamine-dipedptide entriched enteral nutrition can improve the plasma GLN level after severe burn, decrease the gut permeability from early stage, ameliorate wound healing rate on day 30, and reduce hospital stay.

关 键 词:烧伤 谷氨酰胺双肽 肠粘膜通透性 

分 类 号:R644[医药卫生—外科学]

 

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