谷氨酰胺强化早期肠内营养对MODS患者肠屏障功能及预后的影响

目的 探讨谷氨酰胺强化早期肠内营养对多器官功能障碍综合征（Multiple organ dysfunction syndrome,MODS）患者肠屏障功能及近期临床预后的影响.方法 采用随机、对照临床实验,将56例MODS患者分为常规肠内营养治疗组（A组,n=28）和谷氨酰胺强化肠内营养治疗组（B组,n=28）,两组患者接受等氮0.2 g/（kg·d）]、等热量30 kcal/（kg·d）]的治疗,氮与热量比为1：140.A组常规给予肠内营养（能全力,纽迪希亚制药）,B组在常规治疗基础上加用L-丙氨酰-L-谷胺酰胺0.4 g/（kg·d）（力肽,华瑞制药）,另选取同期本院健康查体人员作为对照组（C组,n=15）,分别采血检测患者治疗前、后血浆内毒素（LPS）浓度、D-乳酸水平,留尿测尿乳果糖/甘露醇（L/M）比值,观察患者留驻ICU时间及死亡率.结果 治疗前A、B两组患者血浆LPS、D-乳酸浓度、尿L/M比值较C组显著增高（P〈0.01）;治疗后两组血浆LPS、D-乳酸浓度、尿L/M比值皆有降低,B组较A组下降更为明显（P〈0.05）;B组患者留住ICU时间及死亡率低于A组.结论 谷氨酰胺强化早期肠内营养能较常规肠内营养更好地降低MODS患者肠道通透性,维护肠屏障功能,并能在一定程度上改善预后.

The effect of Gln-enriched early enteral nutrition on intestinal barrier function and outcome in MODS patients

Objective To study the effect of glutamin （Gin） - enriched early enteral nutrition on intestinal barrier function and outcome in patients with multiple organ dysfunction syndrome （MODS）. Methods 56 MODS patients were randomly divided into two groups（ n = 28 ） ：Group A recepted normal early entcral nutrition treatment and Group B reeepted therapy with Glnenriched early enteral nutrition L- Alanyl -L -Glutamine,0. 4 g/（ kg ·d）] ;while Group C was normal control group including 15 healthy individuals. Beth Group A and Group B nutritional intake were isonitrogeanus 0. 2 g/（ kg · d） ] and isocalori 30 keal/（kg · d）] ,The blood plasma levels of LPS and D- lactic acid,urinary L（lactulose） and M（mannitol） ratio （L/M） were detected before and after the treatment. Results （ 1 ） The blood plasma levels of LPS and D - lactic acid and uri- nary IMM were increased significantly in both Group A and Group B compared to Group C （P 〈 0. 01 ） before treatment,were reduced significantly after treatment,those were lower in Group B than in Group A（P 〈0. 05） ; The days in ICU and the death rate were also lower in Group B than in Group A. Concluion Gln- enriched early enteral nutrition therapy may improve intestinal barrier function and outcome in MODS patients.