摘要
目的:探讨围手术期联合补充谷氨酰胺、益生菌对腹部大手术病人术后早期肠黏膜屏障和肠道细菌易位的影响。方法:纳入2018年3月至2018年8月于昆明医科大学第二附属医院择期行腹部肝胆、胃肠外科大手术的病人60例,按随机数字表法分为对照组、观察组,每组30例。观察组较对照组在围手术期常规处理基础上给予补充谷氨酰胺和双歧杆菌乳杆菌三联活菌片。比较两组病人术前及术后12 h、24 h、48 h的血清瓜氨酸浓度和α-谷胱甘肽-S-转移酶浓度及大肠杆菌16SrDNA的拷贝数。结果:术后两组病人血清瓜氨酸浓度与术前比较均降低,组间对比差异有统计学意义(P<0.05);对照组血清α-谷胱甘肽-S-转移酶浓度术后为升高趋势,观察组术后的α-谷胱甘肽-S-转移酶浓度呈波动趋势,组间比较差异有统计学意义(P<0.05);两组病人组内术前、术后外周血大肠杆菌16sDNA拷贝数水平变化差异均有统计学意义(P<0.05),术后各时间点与术前比较,两组均以术后12 h外周血大肠杆菌16sDNA拷贝数水平改变最显著,但对照组和观察组两组间比较差异无统计学意义(P>0.05)。结论:腹部大手术病人围手术期补充谷氨酰胺和益生菌能改善病人早期肠屏障受损预警指标(血清瓜氨酸、α-谷胱甘肽-S-转移酶浓度)的变化趋势,保护肠黏膜屏障。但尚不能明确是否能抑制肠道细菌易位。
Objective:To explore the effects of glutamine combined with probiotics on intestinal mucosal barrier and bacteria translocation in patients with major abdominal surgery at early stage.Methods:Sixty patients who underwent elective major hepatobiliary and gastrointestinal surgery in our hospital from March 2018 to August 2018 were enrolled in this study.The patients were randomly divided into observation group(n=30)and control group(n=30)according to the random number table method.In addition to the routine treatment,the observation group was supplemented glutamine and lactobacillus bifidus triple viable tablet during the perioperative period.The control group was only given routine treatment and nursing.Serum levels of citrulline andα-glutathione S-transferase(α-GST),copy number of blood Escherichia coli 16S rDNA in the patients were measured at preoperative and postoperative(12 h,24 h,48 h)period.Results:The concentrations of the serum citrate in the observation group were significantly higher than in the control group at 24 and 48 h after operations(P<0.05).By contrast,the levels of serumα-glutathione S-transferase(α-GST)in the observation group were lower than in the control group at postoperatively 24 h and 48 h(P<0.05).Compared to preoperative levels,the copy numbers of the peripheral blood Escherichia coli 16S rDNA in both groups were increased after operations,especially at postoperatively 12 h and 24 h(P<0.05).The copy number of the peripheral blood Escherichia coli 16S rDNA in the observation group was lowered than in the control group after operations.However,there was no statistically significant difference between both groups(P>0.05).Conclusion:Perioperative supplementation with combined glutamine and probiotics could alleviate the intestinal mucosal barrier injury in patients after major abdominal surgery.However,it remains to be determined whether the combined supplementation can reduce the presence of intestinal bacteria translocation.
作者
孙岩波
陈永平
李树民
林岳瀛
李为明
孙大力
许青文
李奕俊
岑云云
徐鹏远
SUN Yan-bo;CHEN Yong-ping;LI Shu-min;LIN Yue-ying;LI Wei-ming;SUN Da-li;XU Qing-wen;LI Yi-jun;CEN Yun-yun;XU Peng-yuan(Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Kunming Medical University,Kunming 650000,Yunnan,China;Research Center for Surgical Clinical Nutrition of Yunnan Province,Kunming 650000,Yunnan,China;Department of Hepatobiliary Surgery,the Zigong People's Hospital,Zigong 678000,Sichuan,China)
出处
《肠外与肠内营养》
CSCD
北大核心
2020年第5期265-269,共5页
Parenteral & Enteral Nutrition
基金
云南省外科临床营养研究中心基金项目(2017NS302,2018NS0317,2018NS0318)
云南省基础研究计划[昆医联合专项2019FE001(-223),2019FE001(-167)]
云南省卫生健康委员会医学后备人才培养计划(H-2018067)。
关键词
腹部大手术
肠黏膜屏障
谷氨酰胺
益生菌
Major abdominal surgery
Intestinal mucosal barrier
Glutamine
Probiotics
