CAJ | 학술논문

目的观察谷氨酰胺强化的PN对左半结肠梗阻一期肠切除术后的作用.方法选择广东医学院附属医院胃肠外科收治的左半结肠梗阻行一期肠切除术的患者37例,随机分成研究组18例和对照组19例;对照组术后常规肠外营养,研究组加用谷氨酰胺注射液,持续7d,比较两组患者的炎症反应和临床情况.结果研究组术后第7d白细胞计数、IL-6、APACHE Ⅱ评分低于对照组[(6.4±1.1)×109/L vs(8.9±3.3)×109/L,(16.6±7.1)ng/L vs(28.6±10.3)ng/L,(4.6±1.8)分vs(7.3±2.5)分],差异具有极显著性(P＜0.01);研究组肠功能恢复时间短于对照组[(72.0±5.2)h vs(82.5±7.2)h],差异具有极显著性(P＜0.01);研究组的肺部感染率小于对照组(2/18 vs 8/19),差异具有显著性(P＜0.05);两组患者切口感染率、吻合口瘘发生率(4/18 vs 6/19,2/18 vs 3/19)差异无显著性(P＞0.05),且研究组吻合口瘘发生时间较晚、全身炎症反应较轻,均保守治疗治愈,对照组2例经造瘘治愈.结论谷氨酰胺强化的PN能明显减轻左半结肠梗阻一期肠切除术的炎症反应,控制感染,保护和修复肠道粘膜,促进肠功能恢复,从而达到加速康复外科的作用.
목적 관찰곡안선알강화적PN대좌반결장경조일기장절제술후적작용.방법 선택엄동의학원부속의원위장외과수치적좌반결장경조행일기장절제술적환자37례,수궤분성연구조18례화대조조19례;대조조술후상규장외영양,연구조가용곡안선알주사액,지속7d,비교량조환자적염증반응화림상정황.결과 연구조술후제7d백세포계수、IL-6、APACHE Ⅱ평분저우대조조[(6.4±1.1)×109/L vs(8.9±3.3)×109/L,(16.6±7.1)ng/L vs(28.6±10.3)ng/L,(4.6±1.8)분vs(7.3±2.5)분],차이구유겁현저성(P＜0.01);연구조장공능회복시간단우대조조[(72.0±5.2)h vs(82.5±7.2)h],차이구유겁현저성(P＜0.01);연구조적폐부감염솔소우대조조(2/18 vs 8/19),차이구유현저성(P＜0.05);량조환자절구감염솔、문합구루발생솔(4/18 vs 6/19,2/18 vs 3/19)차이무현저성(P＞0.05),차연구조문합구루발생시간교만、전신염증반응교경,균보수치료치유,대조조2례경조루치유.결론 곡안선알강화적PN능명현감경좌반결장경조일기장절제술적염증반응,공제감염,보호화수복장도점막,촉진장공능회복,종이체도가속강복외과적작용.
Objective To investigate the effect of glutamine-enhancing parenteral nutrition (PN) on the postoperative patients of left colon resection. Methods 37 postoperative patients of left colon resection were randomly divided into study group (18) and control group (19). Study group were treated with glutamine-enhancing PN for 7 days. Control group were treated with normal PN for 7 days. The inflammatory response and the clinical features were compared. Results The white-blood cell count, IL-6 and APACHE Ⅱ score of study group were lowered than those of control group on the 7th day, the difference was statistically significant (P＜ 0.01). The time of intestinal function recovery in study group were shorter than that of control group, the difference was statistically significant (P＜ 0.01). The incidence of lung infection in study group were less than those of control group, the difference was (P＜ 0.05). The incidence of wound infection, anastomotic leakage were not statistically significant (P＞ 0.05). However, the time of anastomotic leakage in study group was later, the inflammatory response was lighter. 2 patients of control group were cured by colostomy. Conclusions Glutamine-enhancing PN can significantly reduce the intestinal inflammatory response of left colonic excision, protect intestinal mucosa and promote the recovery of intestinal function, so as to achieve the effect of fast track surgery.