Abstract
目的 探讨门腔分流术后病人给予含丙氨酰-谷氨酰胺双肽(Ala-GLN)肠外营养(PN)的安全性;观察其营养支持的效果,及对肠道通透性的影响.方法 16例病人随机分为两组.对照组(n=7)接受不含GLN的PN;实验组(n=9)接受含Ala-GLN双肽的PN.两组自术后第1天起给予等氮、等热量的PN共7 d,于PN前后分别测定血清前白蛋白、氮平衡变化、血清GLN浓度、血氨、尿乳果糖/甘露醇排泄率比值(L/M ratio)、生化和临床指标的变化.结果对照组术后血清GLN水平比术前显著降低,术后实验组GLN水平(577±42)μmol/L显著(P=0.009)高于对照组术后水平(499±61) μmol/L;两组术前的L/M比率均明显高于国人正常水平,术后对照组L/M水平(0.095±0.034)显著(P=0.045)高于实验组(0.064±0.023);两组累积氮平衡无显著性差异,但实验组第5～7天期间氮平衡要明显优于对照组,实验组第5天氮平衡(-15.3±46.9)mg·kg-1·d-1显著(P=0.043)好于对照组(-92.7±90.5)mg·kg-1·d-1;对照组术后血清前白蛋白水平较术前显著下降,实验组术后血清前白蛋白水平(0.269±0.037) g/L显著(P=0.001)高于对照组(0.199±0.027) g/L;两组术后血氨水平相比无统计学意义;生化指标的检测也基本无统计学意义;16名病人均顺利接受了门腔分流术,术后恢复良好,无术后并发症发生.结论 Ala-GLN双肽在肝硬化门静脉高压症接受门腔分流术病人中适量的应用是安全的;与不含Ala-GLN双肽的PN 相比,Ala-GLN双肽的添加可维持体内GLN水平并有更好的营养支持效果;并可以改善肠黏膜通透性。
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