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谷氨酰胺强化的肠内营养对手术应激患者肠黏膜通透性的影响
张勇胜1△,舒晓亮2△*,陈胜芳2,汪海峰2,孙贤青2,申颖2
0
(1. 广西医科大学第一附属医院临床营养科,南宁 530027;2.同济大学附属同济医院临床营养科,上海 200065)
摘要:
目的研究谷氨酰胺强化的肠内营养对手术患者肠黏膜通透性的影响。方法216例消化道手术患者随机分为肠外营养(PN)组、肠内营养(EN)组和谷氨酰胺强化的肠内营养(GLN)组。3组患者分别于术后3~11 d给予等氮、等能量(氮0.2 g·kg-1·d-1,能量125.4 kJ·kg-1·d-1)的营养治疗。观察术前 1 d、术后 7 d和术后 12 d口服含乳果糖10 g、甘露醇5 g的测试液后 6 h尿中乳果糖和甘露醇排泄率的比值 (L/M)变化 ,用高效液相色谱法测定尿中乳果糖和甘露醇的浓度。结果3组术后7
关键词:  谷氨酰胺  肠内营养  手术  肠黏膜  通透性
DOI:10.3724/SP.J.1008.2011.0726
投稿时间:2011-01-15修订日期:2011-01-15
基金项目:
Influence of alanyl-glutamine-enriched enteral nutrition on intestinal permeability of patients with abdominal surgical stress response
ZHANG Yong-sheng1△,SHU Xiao-liang2△*,CHEN Sheng-fang2,WANG Hai-feng2,SUN Xian-qing2,SHENG Ying2
(1. Department of Nutrition, the First Affiliated Hospital of Guangxi Medical University, Nanning 530027, Guangxi, China;2. Department of Nutrition, Tongji Hospital ,Tongji University,Shanghai 200065,China)
Abstract:
[ABSTRACT] Objective To examine The impact of alanyl-glutamine-enriched enteral nutrition on intestinal permeability in patients after abdominal operation . Methods Two hundrus and sixteen patients undergone abdominal surgery were randomly divided into three groups and received conventional alanyl-glutamine-enriched enteral nutrition (GLN group), enteral nutrition (EN group) and parenteral nutrition(PN group) with isonitrogenic(0.2gN•kg-1•d-1) and isocarloric(125.4kJ•kg-1.d-1) support from postoperative day (POD) 3 to POD 11.On the day before operation POD 7and POD 12, 10g of lactulose and 5g of mannitol were given ,and 6-hour urine after administration was collected for detecting lactulose / mannitol (L/M)ratio. Results Elevated lactulose/ Mannitol (L/M) ratios were found in all the patients at POD7 as compared to POD l. The elevated ratio returned to control level in EN group and GLN group by day 12, but still remained high in PN group patients at POD12. Conclusions L/M ratio increases in the early period after surgical trauma. Enteral nutrition can provide a better protection against intestinal permeability. And alanyl-glutamine-enriched can improve such protection against intestinal permeability.
Key words:  Glutamine  Enteral nutrition  Operation  Intestinal mucosa  Permeability