中国实用外科杂志

中国实用外科杂志 ›› 2008, Vol. 28 ›› Issue (10): 885-887.

• 论著 • 上一篇    下一篇

谷氨酰胺对腹部手术后肠通透性及细菌易位影响的临床研究

姜海平，张文斌，王希，汤汉林，陈丹，张小勤   

  1. 暨南大学附属第一医院胃肠外科，广东广州510632
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2008-10-01 发布日期:2008-10-01

  • Received:1900-01-01 Revised:1900-01-01 Online:2008-10-01 Published:2008-10-01

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摘要：

目的观察外源性谷氨酰胺（Gln）对腹部手术后病人肠道通透性的影响，继而探讨其与肠细菌易位的关系。方法将暨南大学附属第一医院2004年5月至2007年5月收治的76例腹部大中型手术病人随机分成Gln治疗组（n=38）和对照组（n=38）。两组均于术后第2d开始给予肠外营养支持，持续7d。Gln治疗组于肠外营养中加入Gln。两组分别于术前、术后检测血谷氨酰胺水平、尿乳果糖/甘露醇（L/M）比值、外周血肠源性细菌DNA。结果术后7d治疗组Gln与术前相比差异无统计学意义［(61614±4213) μmol/L vs (611354±3981)μmol/L］，P﹥005。与对照组比较Gln显著升高，差异具有统计学意义， P﹤001。术后L/M比值对照组较术前显著升高，P﹤005；治疗组与术前比较无升高，P﹥005。两组术后相比较对照组高于治疗组，差异具有统计学意义，P﹤001。外周血细菌DNA行PCR扩增后阳性率为1053%（8/76），PCR阳性组Gln水平较PCR阴性组显著降低，P﹤005；L/M则显著增高，P﹤001。结论外源性Gln的补充可以有效的提高腹部手术后病人Gln水平，保护肠黏膜屏障功能，减少细菌易位的发生。

关键词: 谷氨酰胺, 肠通透性, 细菌易位

Abstract:

Effect of glutamine on intestinal permeability and bacterial translocation in patients after abdominal surgeryJIANG Haiping,ZHANG Wenbin,WANG Xi，et al.Department of General Surgery，the First Affiliated Hospital of Jinan University，Guangzhou 510630,China Corresponding author:JIANG Haiping,Email:tjhp@tom.com AbstractObjectiveThe study was conducted to examine the effects of supplemental glutamine (Gln) on intestinal permeability and bacterial translocation in patients undergone abdominal surgery.MethodsFrom May 2004 to May 2007,76 patients in the First Affiliated Hospatial of Jinan University were randomised to receive either parenteral nutrition with Gln （n=38） or the same nutrition alone (n=38) after abdominal surgery.Administration of Gln or parenteral nutrition alone was continued for a further 7 days and intestinal permeability was then measurerd by estimation of urine lactulose/mannito (L/M) and.intestinalderived bacterial DNA examined by PCR after the surgery.ResultsGln in 7d after the surgery was significantly lower in control compared to patients receiving Gln.(control,53286±10708 μmol/L,Gln,61614±4213 μmol/L,P<001).Intestinal permeability (L/M) after the surgery was significantly lower in patients receiving Gln compared to controls,P<001.The incidence of bacterial positive by PCR was 1053% (8/76) after surgery in both groups.Lower levels of Gln were detected in bacterial positive group compared to negative，P<005,and L/M was lower in bacterial negative group significantly compared to positive，P<001.ConclusionGlutamine modulates intestinal permeability and reduces bacterial translocation in patients undergoing abdominal surgery.

Key words: glutaminen, intestinal permeability, bacterial translocation