全胃肠外营养加谷氨酰胺对多器官功能障碍综合征患者血浆二胺氧化酶及D-乳酸的影响

目的探讨添加谷氨酰胺的全胃肠外营养(TPN)对多器官功能障碍综合征(M ODS)患者血浆二胺氧化酶(DAO)、D乳酸的影响。方法将2003年9月—2005年6月收入山东省聊城市人民医院ICU的40例M ODS患者,按随机、对照研究方法分为常规TPN组(A组,20例)和谷氨酰胺+TPN治疗组(B组,20例)。两组患者均接受等氮、等热量的肠外营养(PN)治疗。A组按常规给予TPN;B组在给予TPN基础上加用谷氨酰胺0.27 g.k-g 1.-d 1(相当于力肽0.4 g.k-g 1.-d 1),共7 d。TPN治疗前及治疗后1、3和7 d分别抽血检测血浆DAO和D乳酸浓度,并统计两组PN治疗时间和病死率。同时选20名健康献血员作为正常对照(C组)。所有数据均用SPSS 10.0统计软件进行统计学处理。结果TPN治疗前A、B两组患者血浆DAO、D乳酸水平均显著高于C组(P均<0.01),A、B两组间差异无显著性(P>0.05);B组患者经谷氨酰胺+TPN治疗后,血浆DAO、D乳酸均显著低于A组(P均<0.01)。A组TPN治疗时间为(15.8±2.3)d,B组为(12.5±2.4)d,A组显著高于B组(P<0.05)。A组病死率为25%,B组为10%,两组比较差异无显著性(P>0.05)。结论经静脉补充谷氨酰胺(力肽)有助于增加M ODS患者肠黏膜上皮细胞能量供给,显著降低血浆DAO和D乳酸浓度,缩短TPN治疗时间。

Effect of total parenteral nutrition with supplementation of glutamine on the plasma diamine oxidase activity and D-lactate content in patients with multiple organ dysfunction syndrome

OBJECTIVE: To explore the effect of total parenteral nutrition (TPN) supplemented with glutamine on the activity of plasma diamine oxidase (DAO) and D-lactate content in blood of patients with multiple organ dysfunction syndrome (MODS). METHODS: Forty patients with MODS in the intensive care unit (ICU) from September 2003 to June 2005 were involved in a randomized controlled study, and divided into routine group (group A, n=20), the glutamine +TPN treatment group (group B, n=20). All patients received equivalent nitrogen and caloric values in parenteral nutrition. Group A was given routine TPN, and group B was given extra glutamine 0.27 g.kg(-1).d(-1) (i. e. dipeptiven 0.4 g.kg(-1).d(-1)) for 7 days. The activity of plasma DAO and D-lactate content, the treatment time and the mortality rate of the two groups were determined before TPN, on the 1st, the 3rd and the 7th day after TPN. At the same time, 20 healthy blood donors formed the healthy control group (group C). All the data were analyzed with the SPSS 10.0 software. RESULTS: Before treatment, the activity of plasma DAO and D-lactate content of the two patient groups were significantly higher than those of group C (both P<0.01), and there was no difference between group A and group B (P>0.05). After the treatment of glutamine supplemented TPN, the activity of plasma DAO and D-lactate content of group B were lower than those of group A (both P<0.01). The duration of TPN was (15.8+/-2.3) days for group A and (12.5+/-2.4) days for group B. The former was significantly longer than that of group B (P<0.05). The mortality rate of group A was 25%, the mortality rate of group B was 10%, but there was no significant difference between the two groups (P>0.05). CONCLUSION: The glutamine (dipeptiven) supplementation through vein can help increase the supply of energy substrate to intestinal mucosa epithelium, and decrease the activity of plasma DAO and D-lactate content. It has an important effect on protecting the intestinal mucosa epithelial function. It also helps shorten the TPN treatment course.