谷氨酰胺双肽改善重度烧伤患者肠粘膜通透性的研究

目的 观察严重烧伤后肠粘通透性的变化，研究谷氨酰胺双肽强化的肠内营养对重度烧伤患者肠粘膜通透性的影响。方法 选择２４例烧伤总面积大于３０％，Ⅲ度面积大于２０％的患者加入研究，随机分为对照组，给予安素和谷氨酰胺强化肠内营养组（ＧＬＮ），每组１２例。伤后６小时内开始接受肠内营养液，两组营养供应是等氮等热卡的。ＧＬＮ组在基本肠内营养液中加入粉剂谷氨酰胺双肽每天０．５ｇ／ｋｇ。监测伤后１、１２天血清氨基酸

Glutamine dipeptide enriched enteral nutrition improving gut permeability in sever burns

OBJECTIVE: To determine the effect of glutamine dipeptide on gut permeability in severe burns. METHODS: Twenty-four severe burn patients were randomly divided into two groups: control group and GLN group. All patients received enteral nutrition for 12 days after burn. Both groups were isocaloric and isonitrogen. GLN group patients were given nutrition solution enriched with glutamine dipeptide at a dosage at 0.5 g.kg-1.day-1 (equivalent to L-glutamine 0.3 mg.kg-1.day-1). On the day 1 and 12 after burn, the plasma amino acid was measured by a standard amino acid analyzer. On the day 1, 3, 6 and 12, the gut permeability was detected with Lactulose and Manitol assay by HPLC-PED, and then wound healing rate of burn area was determined on the day 30 and hospital stay was recorded. ANOVA was done for data analysis. RESULTS: The plasma GLN concentrations decreased in both groups on day 1, (control group: 361.3 +/- 70.8 microns/L, GLN group: 348.6 +/- 52.5 microns/L, P = 0.624, normal value: 659.5 +/- 35.0 microns/L), and the GLN group showed high plasma GLN concentration on day 12 (566.4 +/- 128.3 microns/L), with significant difference between control group (417.6 +/- 74.8 microns/L, P = 0.002). On day 1, L/M ratio value was the highest in both groups. On day 3, L/M ratio in the GLN group became lower than that of control group, and returned to normal on day 6 and maintained to day 12. There were significant differences of wound healing rate between the two groups and the length of hospital stay on day 30 (Control group: (81 +/- 7)%, GLN group: (89 +/- 7)%, 0.018) (Control group: 68 +/- 27 days, GLN group: 49 +/- 13 days, P = 0.049). CONCLUSION: The glutamine-dipeptide enriched enteral nutrition can improve the plasma GLN level after severe burn, decrease the gut permeability from early stage, ameliorate wound healing rate on day 30, and reduce hospital stay.