摘要
目的 探讨门腔分流术后病人给予含丙氨酰 谷氨酰胺双肽 (Ala GLN)肠外营养 (PN)的安全性 ;观察其营养支持的效果 ,及对肠道通透性的影响。方法 16例病人随机分为两组。对照组(n =7)接受不含GLN的PN ;实验组 (n =9)接受含Ala GLN双肽的PN。两组自术后第 1天起给予等氮、等热量的PN共 7d ,于PN前后分别测定血清前白蛋白、氮平衡变化、血清GLN浓度、血氨、尿乳果糖 /甘露醇排泄率比值 (L/Mratio)、生化和临床指标的变化。结果 对照组术后血清GLN水平比术前显著降低 ,术后实验组GLN水平 (5 77± 4 2 ) μmol/L显著 (P =0 0 0 9)高于对照组术后水平 (499± 6 1)μmol/L ;两组术前的L/M比率均明显高于国人正常水平 ,术后对照组L/M水平 (0 0 95± 0 0 34)显著 (P=0 0 4 5 )高于实验组 (0 0 6 4± 0 0 2 3) ;两组累积氮平衡无显著性差异 ,但实验组第 5～ 7天期间氮平衡要明显优于对照组 ,实验组第 5天氮平衡 (- 15 3± 4 6 9)mg·kg-1·d-1显著 (P =0 0 4 3)好于对照组 (-92 7± 90 5 )mg·kg-1·d-1;对照组术后血清前白蛋白水平较术前显著下降 ,实验组术后血清前白蛋白水平 (0 2 6 9± 0 0 37)g/L显著 (P =0 0 0 1)高于对照组 (0 199± 0 0 2 7)g/L ;两组术后血氨水平相比无统计学意义 ;
Objective To investigate the safety of Ala-GLN-supplemented parenteral nutrition (PN) and its nutritional support effect and explore its impact on intestinal permeability in patients after portacaval shunt. Methods Sixteen adult patients undergoing portacaval shunt were randomized into 2 groups. The patients (n=9) in the study group received Ala-GLN-supplemented PN while those (n=7) in the control group did not. All the patients in both groups received isonitrogenous and isocaloric PN for 7 d. The values of serum glutamine, prealbumin, nitrogen balance, ammonia and the ratio of lactulose to manicol excreted in urine (L/M ratio), biochemical and clinical markers were determined before and after the PN. Results In the control group, the postoperative serum GLN level was significantly decreased as compared with that before the operation. The postoperative serum GLN level in the study group was significantly higher than the control value (577±42 μmol/L vs 499±61 μmol/L, P=0.009). The preoperative L/M ratio was markedly higher than the Chinese normal level in both groups. The postoperative L/M ratio was significantly higher in the control group than in the study group (0.095±0.034 vs 0.066±0.015, P=0.045). Cumulated nitrogen balance was not statistically different between the 2 groups. However, from the 5th to 7th d, it was better in the study group than in the control group. On the 5th d, it was remarkably higher in the study group than in the control group (-15.3±46.9 mg·kg -1·d -1 vs -92.7±90.5 mg·kg -1·d -1, P=0.043). The postoperative serum prealbumin level was markedly higher in the study group than in the control group (0.269±0.037 g/L vs 0.199±0.027 g/L, P=0.001). The postoperative blood ammonia level and biochemical markers were not significantly different between the 2 groups. All patients successfully underwent the operation and recovered well. No postoperative complications were found. Conclusions Proper dose Ala-GLN-supplemented PN is safe for patients with hepatic cirrhosis receivin
出处
《中华肝胆外科杂志》
CAS
CSCD
2004年第9期579-582,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
含谷氨酰胺双肽
肠外营养
门腔分流术
临床研究
Portacaval shunt,surgical
Glutamine
Parenteral nutrition
Nitrogen balance
Permeability
