含谷氨酰胺双肽TPN临床应用的安全性观察  

Clinical Application of Total Parenteral Nutrition with Glutamine Dipeptide.

作　　者：施咏梅[1] 曹伟新[1] 程庆民[1] 费旭峰[1] 蒋咏梅 金月定[1] 商俊 韩天权 

机构地区：[1]上海第二医科大学附属瑞金医院临床营养科 [2]上海消化外科研究所,200025

出　　处：《外科理论与实践》2000年第1期24-26,共3页Journal of Surgery Concepts & Practice

摘　　要：探讨消化道疾病手术患者接受含谷氨酰胺（Ｇｌｎ）双肽ＴＰＮ的安全性及对血浆蛋白质和血清游离Ｇｌｎ水平的影响。方法：３０例患者随机进入双肽组和对照组，各１５例。术后第１天起连续６ｄ给予等氮（０．２ｇＮ／ｋｇ·ｄ）等热量（１２６ｋＪ／ｋｇ·ｄ）的ＴＰＮ支持。双肽组近５０％的氮由Ｇｌｎ双肽提供。于ＴＰＮ前后分别测定肝、肾功能，血浆蛋白质和血清游离氨基酸谱。结果：ＴＰＮ后两组患者的血浆总蛋白、白蛋白水平均较术前基础值下降，以对照组白蛋白水平下降为显著（Ｐ＜０．０５）；双肽组Ｇｌｎ水平较基础值稍升高，而对照组则见下降，两组比较有显著差异（Ｐ＜０．０５）；所有患者肝、肾功能均无明显变化。结论：含Ｇｌｎ双肽的ＴＰＮ能安全用于手术创伤病人，且能维持血清Ｇｌｎ水平和减轻术后血浆蛋白质水平的下降。To study the effect of glutamine dipeptide containing total parenteral nutrition(TPN) on plasma protein level, serum glutamine(Gln) concentration and drug toxicity in patients undergoing major gastrointestinal surgery. Methods: Patients were randomly allocated into control group(n= 15) and study group(n= 15), receiving isonitrogenous(0.2g nitrogen/kg·d) and isocaloric(126kJ/kg·d) TPN from post-op D1 to post-op D6. Approximately 50% of the nitrogen in the study group was provided by N(2)-L-alanyl -L- glutamine (Ala- Gln). Liver and renal function tests, plasma protein level and aminogram were measured before and after TPN administration. Results: Compared with the basic values before the treatment, plasma total protein and albumin levels in the two groups were both decreased after TPN, the albumin level was markedly decreased in the control group(p<0.05). Serum Gln concentration was slightly increased in the study group while it was decreased in the control group; there was a significant difference between the two groups(p<0.05). No obvious alteration in the liver and renal functions was observed Conclusions: Gln dipeptide containing TPN could be safety administrated to the surgical patients. It helps to maintain serum Gln concentration and to ameliorate the decrease of plasma protein level.

关 键 词：消化道疾病 Gln双肽 TPN 外科手术 

分 类 号：R459.3[医药卫生—治疗学]