摘要
目的研究肠外营养中添加谷氨酰胺对老年人腹部手术预后的影响。方法 48例老年外科患者接受大、中腹部手术后，随机分成两组：研究组和对照组。给予等氮、等热卡的肠外营养，研究组补充 0.5g· kg－ 1· d－ 1的丙氨酰－谷氨酰胺双肽溶液共 5天。于术后第 1、 6天检测两组患者的血生化指标及白细胞介素－ 2(IL－ 2)水平，临床观察握力水平、肛门排气时间、术后 2周内的并发症发生率。结果术后第 1天两组患者的各项指标无明显差异。第 6天研究组的 AKP均值为 97.5± 34.7U/L，对照组为 135.6± 53.9U/L,前者较低（ P=0.043） ;IL－ 2水平研究组为 9.5± 1.7μ g/L,对照组为 7.2± 2.1μ g/L，研究组 IL－ 2水平较高（ P=0.035） ;研究组平均握力为 269.3± 56.5N，较对照组 198.4± 86.1N有明显增高（ P=0.018）。两组的 ALT、 SB、 Alb、 BUN及 Cr值差异不显著。肛门排气时间研究组为 75.8± 8.6h,对照组为 82.4± 9.9h，前者较早（ P=0.029）。研究组术后并发症有 9例，无患者死亡，并发症发生率为 37.5％；对照组为 14例、 58.3％ ,有 1名患者死于 MOSF，研究组并发症发生率较低（ Fisher精确检验： P=0.0185）。结论老年患者腹部手术后给予添加谷氨酰胺的肠外营养是安全的并有助于改善其临床预后。
Objective To evaluate the effect of glutamine－ supplement parenteral nutrition (PN) on prognosis of the abdominal surgery in the aged.Methods 48 aged patients who had undergone moderate to major abdominal surgeries were randomly divided into 2 groups (n=24 each group).All patients received isonitrogenous and isocaloric PN.Ala－ Gln (0.5g· kg－ 1· d－ )instead of part of aminoacids infused,was given to the study group for 5 days.Clinical chemical parameters,concentration of IL－ 2 and the grasp strength were monitored on 1st and 6thday postoperatively. The initiating time of gas evacuation and the incidence of complications within 2 weeks and hospitalization expenses were recorded.Results There was no obvious difference between 2 groups on 1st day.However,on 6th day,compared to the control,AKP in the study group was lower (97.5± 34.7U/L to 135.6± 53.9U/L,P=0.043),IL－ 2comparatively higher (9.5± 1.7μ g/L to 7.2± 2.1μ g/L,P=0.035) and the grasp strength increased markedly (269.3± 56.5N to 198.4± 86.1N,P=0.018) in the study group;ALT,SB,Alb,BUN and Cr of 2 groups showed no statistical difference. The time of gas evacnation was shorter in the study group(75.8± 8.6h to 82.4± 9.9h,P=0.029).There were 9 cases in the study group who had complications post operation,but no dead;14 cases in the control and 1 died of MOSF.The former had a lower incidence (37.5％ to 58.3％ ,Fisher's exact test:P=0.019).Conclusions Glutamine－ supplenent PN was clinically to be safe and beneficial to improve the prognosis of abdominal surgery for the aged.
出处
《老年医学与保健》
CAS
2001年第1期47-48,共2页
Geriatrics & Health Care
