不同途径补充谷氨酰胺对严重烧伤患者的影响  

Effects of Glutamine Supplement with Different Approaches on Patients with Severe Burn

作　　者：任忠亮 薛佳杰 郭雷[1] 郑朝[2] 王耀军[1] 

机构地区：[1]榆林市第二医院烧伤整形手足外科,陕西榆林719000 [2]解放军第四军医大学附属西京医院烧伤科,西安710000

出　　处：《临床误诊误治》2017年第2期82-85,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金资助项目(81401593)

摘　　要：目的探讨不同途径补充谷氨酰胺对严重烧伤患者的影响。方法选择2012年12月—2015年12月榆林市第二医院收治的严重烧伤45例,按照补充谷氨酰胺途径不同,分为口服组(22例)和静脉滴注组(23组)两组。口服组给予谷氨酰胺颗粒口服,静脉滴注组给予丙氨酰-谷氨酰胺二肽静脉滴注,疗程均为2周。观察比较两组治疗第1、2天及第1、2周血浆谷氨酰胺浓度,治疗第1、3天及第1、2周肠黏膜屏障功能指标及脏器损伤指标。结果两组组间治疗不同时间点血浆谷氨酰胺浓度、肠黏膜屏障功能指标及脏器损伤指标比较差异均无统计学意义(P>0.05)。两组治疗第2周血浆谷氨酰胺浓度均高于治疗第1天,差异有统计学意义(P<0.05);两组治疗各时间点二氨氯化酶(DAO)水平均高于正常值,但随着治疗时间延长DAO水平逐渐下降,两组组内治疗各时间点比较差异均具有统计学意义(P<0.05);两组治疗第1天尿乳果糖/甘露醇(L/M)值均明显高于正常水平,治疗第3天L/M值明显回落接近正常值,治疗第1周和第2周L/M值基本回落至正常水平,两组组内治疗各时间点比较差异均具有统计学意义(P<0.05);两组从治疗第1天起至治疗第2周血肌酐、天冬氨酸转氨酶、尿素、乳酸脱氢酶、丙氨酸转氨酶、肌酸激酶同工酶及总胆红素逐渐降低,两组组内治疗各时间点比较差异均具有统计学意义(P<0.05)。结论口服和静脉滴注补充谷氨酰胺治疗严重烧伤均效果良好,且治疗效果相当。Objective To investigate effects of Glutamine supplement with different approaches on patients with severe burn. Methods A total of 45 patients with severe burn admitted during December 2012 and December 2015 were divided into oral group （n = 22） and intravenous drip group （n = 23）. Oral group was given Glutamine particles orally, while intravenous drip group was given Alanyl Glutamine Dipeptide by iv gtt, and the course of treatment was two weeks in each group. Glutamine concentrations in plasma at 1st and 22nd d, and in 1st and 22nd week of treatment, indexes of enteral mucous membrane barrier function and organ injury at 1st and 3rd d, and in 1st and 22ns week of treatment were observed and compared between two groups. Results In two groups, there were no significant differences in Glutamine concentrations, indexes of enteral mucous membrane barrier function and organ injury at different time points （P 〉 0.05 ） ; Glutamine concentrations in 2nd week of treatment were significantly higher than those at 1st d of treatment; diamine oxidase （DAO） levels at every time point were significantly higher than the normal level, but the levels were decreasing with lengthening treatment time, and there were significant differences in DAO levels at different time points in each group （P 〈 0.05） ; urine lactulose/mannitol （L/M） values at 1st d of treatment were significantly higher than the normal value, while L/M values at 3rd d of treatment were obviously near the normal value, and the values in 1st and 22nd week of treatment returned to the normal value, and the differences in L/ M values at different time points in each group were statistically significant （ P 〈 0.05 ） ; levels of serum creatinine （Cr） , as- partate transaminase （AST） , blood urea nitrogen （BUN） , lactate dehydrogenase （LDH） , alanine transarninase （ALT） , MB isoenzyme of creatine kinase （CK-MB） and total bilirubin （TBIL） were generally decreased from 1 ~＇ d to 22＂d week of treat- ment, a

关 键 词：烧伤 谷氨酰胺 投药 口服 输注 静脉内 

分 类 号：R644[医药卫生—外科学]