谷氨酰胺联合乌司他丁对严重烧伤患者炎症反应的影响  

Effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury

作　　者：孙勇 王良喜 周宜芳 孙曙光 毛学飞 邓向东 张盼 

机构地区：[1]解放军第九七医院烧伤整形科,江苏省徐州市221004

出　　处：《中华烧伤杂志》2013年第4期349-354,共6页Chinese Journal of Burns

基　　金：国家自然科学基金，南京军区医学科研课题重点项目，解放军第九七医院院管课题

摘　　要：目的观察谷氨酰胺联合乌司他丁对严重烧伤患者炎症反应的影响。方法选择笔者单位2010年1月-2011年12月收治人院且符合人选标准的60例严重烧伤患者，按照随机数字表法分为常规治疗组20例、谷氨酰胺组20例、联合用药组20例，另选10名健康志愿者作为健康对照组。3组烧伤患者于伤后2d起均给予等氮、等热量的营养支持；给予谷氨酰胺组患者的蛋白质中0．3g／kg由谷氨酰胺双肽提供，使用10d；联合用药组患者同谷氨酰胺组处理，另在应用谷氨酰胺双肽的10d中7d静脉注射乌司他丁100kU，每隔8h注射1次。5组烧伤患者于治疗前1d和治疗后10d收集24h尿液，用微量凯氏定氮法测定尿液总氮量，计算氮平衡；于该2个时相点取静脉血分离血清，比色法测定D-乳酸含量，ELISA法测定二胺氧化酶（DAO）、TNF-α和IL-6含量，鲎试剂动态浊度法测定LPS含量。健康对照组检测相同指标。记录3组患者伤后30d创面愈合率、总住院日、脓毒症发生率。计量资料行单因素方差分析、LSD检验、t检验，计数资料行X2检验。结果治疗后10d谷氨酰胺组患者的氮平衡为（-1．35±0．59）g／d，显著高于常规治疗组[（-5．40±1．67）g／d，P〈0．01]，血清D哥L酸、DAO、LPS、TNF-α以及IL-6含量显著低于常规治疗组（P〈0．05或P〈0．01）。治疗后10d联合用药组患者的氮平衡、D-乳酸和DAO含量与谷氨酰胺组接近（P值均大于0．05）。联合用药组患者治疗后10d血清中LPS、TNF—α和IL-6含量分别为（0．167±0．064）EU／mL、（43±14）pg／mL、（139±23）pg／mL，均低于谷氨酰胺组[（0．240±0．079）EU／mL、（59±8）pg／mL、（195±31）pg／mL，P〈0．05或P〈0．01]。谷氨酰胺组患者伤后30d的创面愈合率、总住院日分别大于或小于常规治疗组（P值均小于0．01），但脓毒症发生率与常规治疗组接近（P〉0．05）。联合用药组患Objective To observe the effects of glutamine combined with ulinastatin on inflammato- ry response of patients with severe burn injury. Methods Sixty patients with severe burn injury admitted to our burn wards from January 2010 to December 2011 conforming to the study criteria were divided into control group （C, n = 20） , glutamine group （G, n = 20） , and glutamine combined with ulinastatin group （ G ＋ U, n = 20） according to the random number table. Another 10 healthy volunteers were chosen as nor- mal control group （ NC）. Isonitrogenous and isocaloric nutrition supports were given to patients in groups C, G, and G ＋ U from post burn day （PBD） 2. 0.3 g/kg protein in the form of glutamine dipeptide was given to patients in group G for 10 days. 0.3 g/kg protein was given to patients in group G ＋ U for 10 days with the same amount of glutamine dipeptide as that in group G, followed by intravenous injection of 100 kU ulinasta- tin （once per 8 hours） for 7 days during 10 days. The nitrogen concentration of 24 h urine was determined with Kieldahl nitrogen determination method, and nitrogen balance was calculated one day before treatment and ten days after treatment. Meanwhile, the levels of D-lactate in serum was determined by colorimetrie method, the levels of diamine oxidase （DAO） , TNF-α, and IL-6 by enzyme-linked immunosorbent assay, and LPS level by kinetic turbidimetric assay with TAL. Above-mentioned indexes were also examined in group NC. The wound healing rate on PBD 30, total hospital stay days, and the incidence of burn sepsis of all burn patients were recorded. Data were processed with one-way analysis of variance, LSD test, t test, and chi-square test. Results Compared with that in group C [ （ - 5.40 ±1.67 ） g./d ] , nitrogen balance in group G was significantly increased ten days after treatment [ （ - 1.35 ± O. 59 ） g/d, P 〈 0.01 ]. The serum levels of D-lactate, DAO, LPS, TNF-α, and IL-6 in group G ten days after treatment were significantly low- er than t

关 键 词：烧伤 谷氨酰胺 乌司他丁 全身炎症反应综合征 

分 类 号：R644[医药卫生—外科学]