围手术期应用谷氨酰胺双肽对血内毒素水平、血浆灭活内毒素能力及预后的影响(随机、双盲、对照的临床研究)  

Role of Perioperative Glutamine-Dipeptide Supplementation on Plasma Endotoxin Level,Plasma Endotoxin Inactivation Capacity,and Clinical Outcome

作　　者：姚国相[1] 蒋朱明[1] 王秀荣[1] 马恩陵[1] 杨乃发[1] 赵玉沛[1] 唐伟松[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院外科,北京100730

出　　处：《中国临床营养杂志》2002年第1期19-23,共5页Chinese Journal of Clinical Nutrition

基　　金：国家自然科学基金(39970723);卫生部重点项目基金(2001-2004年外1-8A)资助

摘　　要：目的研究围手术期应用谷氨酰胺双肽对血浆内毒素水平、血浆灭活内毒素能力及预后的影响。方法采用前瞻、随机、双盲和对照的研究设计,28例患者参加研究。研究组和对照组所接受的氮量和热卡相同;研究组在术前1天到术后3天接受谷氨酰胺双肽0.5g·kg-1·d-1(20%Dipetiven,FreseniusKabi),对照组接受相同氮量的平衡氨基酸。患者分别于手术前1天,术后3和24小时,4天和第7天取外周血。测定血浆内毒素水平和血浆灭活内毒素能力。监测与感染有关的并发症、肠外营养用药费用、总住院费用和术后住院日。结果28例患者均完成研究。数据输入电脑,核对无误后开盲,进入对照组14例,研究组14例。两组术前术后各时间点血浆内毒素水平差值间无显著性差别(P=0.08～0.91);而血浆灭活内毒素能力在术后3d研究组较对照组增强犤差值分别为(+0.157±0.020)EU/ml和(+0.109±0.004)EU/ml,P=0.01犦。对照组出现2例与感染有关的并发症,研究组未出现,组间无显著性差异(P=0.31)。研究组肠外营养用药费用(4302±749)元较对照组(3322±806)元高出(980±772)元,组间无显著性差别(P=0.12);总住院费用研究组为(24816±7291)元较对照组(26194±6372)元低(1368±1081)元,组间无显著性差别(P=0.39);研究组术后住院日数(10.7±1.5)天较对照组(12.1?Objective To evaluat the role of perioperative glutamine-dipeptide supplementation on plasma endotoxin level,plasma endotoxin inactivation capacity and clinical outcome.Method It was a prospective,controlled,double blinded clinical trial.Study group and control group had isonitrogenous and isocaloric intake.Study group patients received0.5g/kg glutamine dipeptide(Dipeptiven,Frese-nius Kabi,Bad Homberg,Germany)each day.Blood samples were obtained1day before operation,3hours after operation,1day after operation,3days and7days after operation.Results28patients were enrolled in this study.After opening code there were14patients in the control group and14patients in the study group.Plasma endotoxin levels were elevated in the study group postoperatively but not significant,while enhanced plasma endotoxin deactivation capacity were noted on the3rd postoperative day(△values:0.157±0.020EU/ml vs0.109±0.004EU/ml,P=0.01),no significance on the other postoperative end points though these levels were enhanced.2cases in the control group complicated with infectious complications(P=0.31).Shortened hospital stay was noticed in the study group(10.7±1.5days vs12.1±1.5days,P=0.04).Conclusion Parenterally supplemented glutamine-dipeptide enhan ced plasma endotoxin deactivation capacity and shortened postoperative hospital stay.

关 键 词：谷氨酰胺双肽 血内毒素 血浆毒素灭活能力 围手术期 预后 肠外营养 

分 类 号：R459.3[医药卫生—治疗学]