谷氨酰胺对重症胰腺炎患者病程的影响  

Effect of glutamine on disease course in severe pancreatitis patients

作　　者：冉军[1] 朱勇[2] 

机构地区：[1]辽宁医学院附属第三医院老年病科,辽宁省锦州市121000 [2]辽宁医学院附属第三医院急救医学科,辽宁省锦州市121000

出　　处：《世界华人消化杂志》2014年第33期5159-5163,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨不同肠外营养方案对重症胰腺炎(severe acute pancreatitis,SAP)患者自然病程的影响.方法:回顾性研究2010-01/2013-06在辽宁医学院附属第三医院住院治疗的SAP患者50例,用随机数字表的方法将其随机分为试验组(n=25)和对照组(n=25),两组均进行为期1 wk的常规肠外营养治疗,其中试验组在此基础上加入谷氨酰胺.观察并比较两组患者治疗前后血/尿淀粉酶、肝功、肾功、血常规、免疫球蛋白、急性生理与慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、Balthazar CT评分、总住院时间、ICU住院时间、机械通气时间、肠道功能恢复时间及并发症发生情况.结果:两组患者治疗后,血尿淀粉酶、肾功总体呈下降趋势,差异无统计学意义(P>0.05);对照组丙氨酸氨基转移酶(46.3 U/L±30.1U/L v s 25.1 U/L±21.3 U/L)、门冬氨酸转移酶(31.0 U/L±15.3 U/L vs 20.5 U/L±11.7U/L)、白细胞(14.8×109/L±4.3×109/L v s8.7×109/L±2.1×109/L)及C反应蛋白(39.8m g/L±6.5 m g/L v s 30.2 m g/L±6.3 m g/L)均显著高于试验组,且差异有统计学意义(P<0.05);两组A PA C H EⅡ评分及B a l t h a z a r C T评分差异无统计学意义(P>0.05);而试验组免疫球蛋白Ig A(2.4 g/L±0.2 g/L vs 1.7g/L±0.2 g/L)、Ig G(9.8 g/L±1.2 g/L vs 8.7g/L±1.0 g/L)及Ig M(1.2 g/L±0.9 g/L vs 0.7g/L±0.8 g/L)水平显著高于对照组,差异有统计学意义(P<0.05);同时,对照组患者总住院时间(32.3 d±6.2 d vs 20.6 d±4.5 d)、ICU住院时间(13.9 d±3.1 d vs 10.2 d±2.5 d)、机械通气时间(8.4 d±2.1 d vs 5.2 d±1.3 d)及肠道功能恢复时间(4.4 d±1.2 d vs 3.6 d±1.0 d)均明显高于试验组,差异有统计学意义(P<0.05).结论:含谷氨酰胺的肠外营养能够显著地缩短患者住院及机械通气时间,一定程度地降低了感染等并发症的风险,可显著改善患者预后.AIM： To assess the influence of different parenteral nutrition（PN） regimens on the course of disease in severe acute pancreatitis（SAP） patients. METHODS： Clinical data for 50 SAP patients treated at our hospital from January 2010 to June2013 were retrospectively analyzed. The patients were randomly divided into either a study group（n = 25） or a control group（n = 25）. Both groups underwent conventional PN therapy for one week. The study group was additionally given glutamine. The levels of amylase in urine and blood, liver function, renal function, routine blood parameters, serum complement, APACHEⅡ score, Balthazar CT score, total hospital stay,ICU stay, mechanical ventilation time, time to recovery of intestinal function and the incidence of complications were compared between the two groups. RESULTS： After treatment, the levels of amylase in urine and blood and renal function showed a declining trend, and there were no statistically significant differences between the two groups（P 〉 0.05）. Alanine aminotransferase（46.3 U/L ± 30.1 U/L vs 25.1 U/L ± 21.3 U/L）, aspartase aminotransferase（31.0 U/L ± 15.3U/L vs 20.5 U/L ± 11.7 U/L）, white blood cell count（14.8 × 109/L ± 4.3 × 109/L vs 8.7 × 109/L± 2.1×109/L） and C-reactive protein（39.8 mg/L± 6.5 mg/L vs 30.2 mg/L ± 6.3 mg/L） were significantly higher in the control group than in the study group（P 〈 0.05）. APACHE Ⅱ score and Balthazar CT score had no significant differences between the two groups（P 〉 0.05）. The levels of Ig A（2.4 g/L ± 0.2 g/L vs 1.7 g/L ± 0.2g/L）, Ig G（9.8 g/L ± 1.2 g/L vs 8.7 g/L ± 1.0 g/L）and Ig M（1.2 g/L ± 0.9 g/L vs 0.7 g/L ± 0.8 g/L）were significantly higher in the study group（P〈 0.05）. Total hospital stay（32.3 d ± 6.2 d vs 20.6d ± 4.5 d）, ICU stay（13.9 d ± 3.1 d vs 10.2 d ± 2.5d）, mechanical ventilation time（8.4 d ± 2.1 d vs5.2 d ± 1.3 d） and the time to recovery of intestinal function（4.4 d ± 1.2 d vs 3.6 d ± 1.0 d） were all

关 键 词：重症胰腺炎 肠外营养 谷氨酰胺 随机对照研究 

分 类 号：R657.51[医药卫生—外科学]