摘要
目的探讨静脉补充谷氨酰胺双肽对重度烧伤患者术后肠粘膜通透性及血浆内毒素浓度的影响。方法30例烧伤总面积30%～50%、Ⅲ°面积15%～25%的患者随机加入对照组和研究组,每组15例。两组患者手术后接受静脉营养治疗,研究组接受静脉谷氨酰胺双肽0.5g·kg-1d-1,对照组仅以平衡氨基酸提供氮源。两组营养供应等氮等热卡。检测术前第1天、术后第1天、术后第12天,血浆谷氨酰胺浓度、尿乳果糖和甘露醇排出率比率(L/M)、血浆内毒素浓度,检查术后12天植皮成活率、创面愈合时间及治疗费用,数据用SPSS11.0进行统计分析。结果两组血浆谷氨酰胺浓度术前第1天均显著低于正常值,对照组(390.6±43.7)μmol/L,研究组(386.7±51.8)μmol/L,正常值(659.5±35)μmol/L;术后第1天,对照组血浆谷氨酰胺浓度显著下降,但研究组上升,两组差异显著(P=0.000);术后第12天,研究组接近正常值,高于对照组,对照组(397.8±38.7)μmol/L,研究组(532.1±48.9)μmol/L(P=0.000)。两组L/M值术前第1天显著高于正常值,对照组0.103±0.050,研究组0.112±0.045,正常值0.022±0.0016;术后第1天两组L/M值均比术前升高,但研究组显著低于对照组,对照组0.175±0.022,研究组0.138±0.039(P=0.003);术后第12天,研究组恢复正常,优于对照组。两组血浆内毒素浓?
Objective To determine the effect of glutamine dipeptide on gut permeabilit y and plasma endotoxin and outcome after operation of the severely burned.Met hods 30severely burned patients were randomized into th e control group and th e study group.The patients received isocaloric and isonitrogen nutritionous aft er burn.Study group patients were given glutamine dipeptide at the dose of 0.5g·kg-1 day-1 .At the day1befoere operative,post operative day1(POD+1),POD+12 ,the plasma amino acid was measured by a standard amino acid analyzer,the gut permeability were detected with Lactulose and Manitol assay by HPLC-PED and pl asma endotoxin was measured by limulus lysate test.The wound infection rate of skin grafting area was determined on POD+12,wound healing time and total c ost was recorded.SPSS11.0was used for data analysis.Results The plasma gl utamine concentration decreased in both group patients on day1before operation (control group390.6±43.7ìmol/L,study group386.7±51.8ìmol/L,normal value659.5±35.0ìmol/L),the study group patients showed h igh plasma glutamine concentration on POD+1,POD+12,the difference compar ed with the control group was significant.On day1before operation L/M ratio va lue is the highest in both groups (control0.103±0.050,study0.11 2±0.045,normal value0.022±0.0016).On POD+1,POD+12L/M ratio in the study group patients became lower than those of the control group ones,the difference was significant.The plasma endotoxin concentration was h igh in both groups on day1before operation(control0.041±0.009,stud y0.043±0.009,normal value0.016±0.0086EU/ml),The study group decreased and became lower than the control on POD+1and POD+3the diff erence was significant,The wound healing time and total cost were both favorit e in the study group.Conclusion The glutamine dipeptide had good effect on impr oving the plasma glutamine level,attenuated the increasing of gut permeabilit y and decreased plasma endotoxin level,ameliorated postoperative wound healing .
出处
《中国临床营养杂志》
2003年第1期14-18,共5页
Chinese Journal of Clinical Nutrition
基金
卫生部重点项目基金(1997-195
2001-外1-8A)
国家自然科学基金(3990723)
