谷氨酰胺强化的肠外营养对肠瘘病人腔静脉导管感染的影响

目的:观察谷氨酰胺(Gln)强化的肠外营养(PN)对肠瘘病人腔静脉导管感染(CRI)的发生率及细菌谱的影响.方法:对2002年10月至2003年12月该院收治的使用腔静脉导管进行PN的肠瘘病人进行前瞻、随机研究.对照组接受常规全肠外营养(TPN),Gln组在常规TPN中加入力肽100ml.结果:117例肠瘘病人,共进行139次腔静脉置管.对照组71例病人共进行84次腔静脉置管,细菌定植的发生率为26.2%,导管相关性血行感染(CRBSI)的发生率为6.0%.Gln组46例病人共进行55次腔静脉置管,细菌定植的发生率为12.7%,CR-BSI为1.8%.Gln组和对照组病人革兰阴性细菌感染的发生率分别为3.6%与16.7%,二者有显著性差异(P=0.037).结论:Gln强化的PN可以减少肠瘘病人CRI的发生,尤其是来源于肠道的革兰阴性菌的感染.

Effects of glutamine enriched parenteral nutrition on catheter-related infection in gastrointestinal fistula patients

Objectives: To determine the effect of glutamine (Gln) enriched parenteral nutrition on morbidity and bacteria spectrum of catheter-related infection (CRI) in gastrointestinal fistula patients. Methods: The gastrointestinal fistula patients who received TPN by central venous catheters during October 2002 to December 2003 were enrolled in this prospective, randomized trial. Controlled group received conventional TPN, and Gln group received conventional TPN and 100ml Dipeptiven. Results: One hundred and thirty nine central venous catheters were inserted in 117 patients. 84 catheters were inserted and catheter colonization and CR-BSI were 26.2% and 6.0% respectively in Controlled group of 71 patients. 55 catheters were inserted and catheter colonization and CR-BSI were 12.7% and 1.8% respectively in Gln group of 46 patients. Significantly fewer bacteremic episodes with Gram-negative organisms occurred in the Gln-supplemented patients(3.6% vs 16.7%, P= 0.037 ). Conclusions: Glutamine supplementation can decrease morbidity of CRI in gastrointestinal fistula patients, especially gut-derived Gram-negative infection.