谷氨酰胺早期营养对全胃切除术后患者的影响  

Early enteral nutrition supplemented with glutamine on the clinical outcomes of patients after total gastrectomy

作　　者：胡俊峰[1] 孙元水[1] 许晓东[1] 邵钦树[1] 

机构地区：[1]浙江省人民医院胃肠外科,杭州310014

出　　处：《浙江医学》2013年第24期2155-2157,共3页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2010KYA014)

摘　　要：目的探讨谷氨酰胺(Gln)早期营养对全胃切除术后患者的影响。方法选取全胃切除患者75例,肠内添加Gln的肠内营养组(EN-Gln组)、静脉添加Gln的肠内营养组[EN-Gln(d)组]及标准肠内营养组(EN组)各25例。均于术前1d及术后1、7、12d测定肠黏膜功能、营养状况及免疫功能指标。结果术后7、12d,与EN组比较,EN-Gln(d)组和EN-Gln组DAO、TNF-α水平及尿中乳果糖与甘露醇比值均明显降低,血清白蛋白(ALB)、转铁蛋白(TAB)、前清蛋白(TF)、IgG、IgA水平及CD4^+/CD8^+均明显升高,差异均有统计学意义(均P<0.05)。EN-Gln(d)组与EN-Gln组各时点DAO、TNF-α、ALB、TAB、TF、IgG、IgA水平及L/M、CD4^+/CD8^+比较的差异均无统计学意义(均P>0.05)。结论谷氨酰胺早期肠内营养治疗可明显增强全胃切除患者的免疫力和营养状况,有利于快速修复肠黏膜屏障通透性,有助于改善临床预后。Objective To investigate the effect of early enteral nutrition supplemented with glutamine on clinical outcoms of patients after total gastrectomy. Methods Seventy five patients undergoing total gastrectomy and receiving total enteral nutri- tion support were randomly assigned to enteral nutrition group with enteral glutamine （EN-GIn, r~=25）, enteral nutrition group with parenteral glutamine[EN-Gln（d）,n=25] and enteral nutrition group without glutamine （EN, n=25）. The intestinal mucosal barrier function, the nutrition status and immune function were evaluated at 1 d before and ld, 7d, 12 d after operation. Results Com- pared to EN group, the ratio of L/M, DAO and TNF- α in EN-GIn（d） group and EN-GIn group were significantly decreased （P〈 0.05） at 7 and 12 d after operation, while the ALB, TAB, TF, IgG, IgA and CD4＋/CD8＋ were significantly increased（P〈0.05）. Con- clusion Enteral nutrition supplemented with Gin can enhance the nutrition status and immune function of patients after total gas- trectomy, promote the recovery of bowel function and improve their early clinical outcomes.

关 键 词：谷氨酰胺 肠内营养 全胃切除 

分 类 号：R656.6[医药卫生—外科学]