丙氨酰谷氨酰胺早期干预小儿重症阑尾炎细菌移位的临床研究  

The clinical study of early intervention of Alanyl-glutamine on Bacterial translocation in Critically ill children with severe appendicitis

作　　者：刘媛[1] 王建峰[1] 段建飞[1] 席红卫[2] 赵瑞玲[2] 

机构地区：[1]山西医科大学儿科系,太原030001 [2]山西省儿童医院,030013

出　　处：《中国医疗前沿》2012年第1期6-8,共3页China Healthcare Innovation

基　　金：山西省科技攻关项目(编号:20080311064-2)

摘　　要：目的探讨丙氨酰谷氨酰胺强化的肠外营养液对小儿重症阑尾炎细菌移位的早期干预及临床意义。方法随机收集山西省儿童医院2011年1-12月40名小儿急性化脓性阑尾炎,其中急性化脓性阑尾炎并穿孔合并泛发性腹膜炎、肠梗阻、腹腔多发脓肿或早期感染性休克为重症组,急性化脓性阑尾炎局限性腹膜炎为普通组,术后两组患儿在接受同等级别抗生素的基础上,重症组添加丙氨酰谷氨酰胺(1.5ml.kg-1.d-1)强化的肠外营养液治疗,常规治疗7d,两组患儿术前、术后7d分别抽外周静脉血5ml,1mlPCR检测全血细菌;1ml测淋巴细胞亚群T(CD3+)、Th(CD3+CD4+)、Ts(CD3+CD8+)、Th/Ts(CD4+/CD8+);其余检测血生化、血常规。结果⑴术后7d两组细菌移位率均较术前降低,重症组细菌移位率接近于普通组;⑵术前两组患儿淋巴细胞亚群T、Th、Th/Ts较正常水平降低,以重症组更为明显(P<0.05),术后7d两组间T、Th、Th/Ts均恢复正常,组间无统计学差异(P>0.05),术前重症组Ts降低,但无统计学意义;⑶两组ALT及TBIL术前后变化不明显。结论丙氨酰谷氨酰胺强化的肠外营养液在小儿重症阑尾炎术后早期干预,对细菌移位具有防治作用,可减轻肠粘膜损害,增强免疫促进术后恢复,简单实用并发症少。Objective To explore early intervention and clinical significance of Alanyl-glutamine enhanced parenteral nutrition on bacterial translocation in critically ill children with severe appendicitis.Methods Collection 40 critically ill children with Acute suppurative appendicitis of Children＇s Hospital of Shanxi Province from January to December 2011 at Random,with acute suppurative appendicitis and perforation,the merger of generalized peritonitis,intestinal obstruction,abdominal abscess or multiple early septic shock as severe group,the limitations peritonitis of acute suppurative appendicitis as an ordinary group,two groups of children receiving antibiotics which was based on the same level,while,the severe group was added alanyl-glutamine（1.5ml·kg-1·d-1） enhanced parenteral nutrition,treatment for 7 days conventionally,two groups of all children before surgery,7d after the operation peripheral venous blood were taken respectively 5ml,1.5ml of blood which increases sodium citrate,PCR detection of bacteria in whole blood;1ml measuring lymphocyte subsets T（CD3＋）,Th（CD3＋CD4＋）,Ts（CD3＋CD8＋）,Th/Ts（CD4＋/CD8＋）;The remaining blood biochemical blood test.Results ①7d after the operation,two groups of bacterial translocation rate was lower than the preoperative,severe group bacterial translocation rate was close to ordinary group;②Preoperative T,Th,Th/Ts of two groups lower than normal level,the severe group was more significantly（P0.05）;postoperative T,Th,Th/Ts of the two groups returned to normal,were no significant difference（P0.05）,Preoperative Ts was low,but no significant difference.③ALT and TBIL did not change significantly before and after surgery.Conclusion In the early intervention Alanyl-glutamine enhanced parenteral nutrition in critically ill children with severe appendicitis prevent and treat bacterial translocation,reduce the intestinal damage,enhance immune to promote postoperative recovery and especially the way is simple practical and less complications.

关 键 词：阑尾炎 细菌移位 T淋巴细胞亚群 丙氨酰谷氨酰胺 

分 类 号：R725.7[医药卫生—儿科]