术后早期肠道通透性改变及其与全身炎症反应的关系

目的 :通过观察胃肠道应用谷氨酰胺 (glutamine ,Gln)对腹部手术后病人早期肠道通透性的影响 ,继而探讨其与全身炎症反应的关系。　方法 :2 0例腹部手术病人以前瞻、双盲、随机的方法分为Gln组和对照组 ,每组各 10例。从术后第 1天开始 ,Gln组每天胃肠道应用Gln颗粒剂 30 g ,共 7天 ;对照组每天应用安慰颗粒剂 30 g ,共 7天。于用药前、后分别检测血清Gln浓度和反映肠道通透性与全身炎症反应有关的实验指标 [尿乳果糖 /甘露醇比值(lactulose/mannitol,L/M)、血清二胺氧化酶、内毒素、丙二醛 ]和临床表现 (体温、心率和血白细胞计数 )。　结果 :对照组的血清Gln浓度从用药前 (432 .17± 14 2 .6 8) μmol/L下降至用药后 (2 5 0 .78± 77.10 ) μmol/L(P <0 .0 1) ,Gln组则由用药前 (36 1.17± 16 1.2 5 ) μmol/L升高至用药后 (5 83.2 2± 171.5 2 ) μmol/L(P <0 .0 5 )。对照组和Gln组用药前尿L/M比值分别是 134.0 0± 18.4 8和 14 6 .10± 2 0 .2 1(P >0 .0 5 ) ,用药后对照组尿L/M比值显著升高 ,Gln组则显著降低 ,分别是 194 .83± 4 5 .31和 117.4 7± 2 5 .6 8,组间比较差异非常显著 (P <0 .0 1)。用药 7天后 ,Gln组的血清二胺氧化酶、内毒素、丙二醛均较用药前显著降低。反映全身炎症反应的临床指

Change in early postoperative intestinal permeability and its relation with systemic inflammatory response

Objectives:To study the effects of glutamine on the change of intestinal permeability and investigate its relationship with systemic inflammatory response in abdominal postoperative patients. Methods: A prospective, randomized, double blind and controlled trial was taken. 20 patients who underwent abdominal surgery were randomized into two groups: Gln group(orally administrated glutamine, 30 g/d, for 7 day, n =10) and placebo group(orally administrated placebo, 30 g/d, for 7 day, n =10). Temperatures and heart rates of all patients were daily recorded during administration. The white blood cell counts and biochemical variables were measured before operation and days 4 and 7 after administration. Serum concentrations of glutamine, endotoxin, diamine oxidase and malondialdehyde and urine lactulose/mannito(L/M) ratio were measured before and the 7th day after administration. Results:The patients in the two groups were comparable prior to the administration. Serum Gln concentration was significantly decreased in placebo group and increased in Gln group after 7 days of administration. Urine L/M ratio was significantly increased in placebo group and decreased in Gln group. The serum concentrations of endotoxin, diamine oxidase and malondialdehyde were significantly decreased in Gln group when compared with those in placebo group. Temperatures, heart rates and WBC counts were significantly lower in Gln group than in placebo group. Conclusions:The gut is one of the sources of the systemic inflammatory response in abdominal postoperative patients and the glutamine can decrease the intestinal permeability,maintain the intestinal barrier and attenuate the systemic inflammatory response in the early period of postoperative patients.