谷氨酰胺强化肠内营养对结肠癌患者左半结肠切除术后肠通透性及感染并发症的作用

摘要

目的 观察谷氨酰胺强化肠内营养对结肠癌患者左半结肠切除术后肠通透性及感染并发症的作用.方法 选取2013年8月—2016年6月在沧州市中心医院行左半结肠切除术治疗的结肠癌患者80例,按照随机数字表法将其分为对照组和观察组,每组各40例.对照组给予常规肠内营养,观察组在常规肠内营养基础上给予谷氨酰胺强化肠内营养.比较两组肠通透性指标〔尿乳果糖/甘露醇(L/M)比值、血浆二氨氧化酶(DAO)、D-乳酸、肿瘤坏死因子α(TNF-α)〕、营养指标(血清清蛋白和前清蛋白)、肠鸣音恢复时间与住院时间及感染并发症发生率.结果 对照组和观察组术后2、7 d尿L/M比值、血浆DAO、血浆D-乳酸、TNF-α水平高于术前1 d,术后7 d尿L/M比值、血浆DAO、血浆D-乳酸、TNF-α水平低于术后2 d(P<0.05).观察组术后2、7 d尿L/M比值、血浆DAO、血浆D-乳酸、TNF-α水平均低于对照组(P<0.05).对照组术后2、7 d清蛋白和前清蛋白水平均低于术前1 d,术后7 d清蛋白和前清蛋白水平均高于术后2 d(P<0.05);观察组术后2 d清蛋白和前清蛋白水平低于术前1 d,术后7 d清蛋白和前清蛋白水平高于术后2 d(P<0.05);观察组术后2、7 d清蛋白和前清蛋白水平均高于对照组(P<0.05).观察组肠鸣音恢复时间和住院时间均低于对照组(P<0.05).观察组感染并发症发生率为7.5%(3/40),低于对照组的27.5%(11/40)(χ2=5.486,P=0.019).结论 对结肠癌左半结肠切除术患者给予谷氨酰胺强化肠内营养支持可维持肠黏膜通透性,保护肠黏膜屏障功能,减少感染并发症的发生.%Objective To observe the effects of nutrient enrichment with glutamine on intestinal permeability and infectious complications after left colonic resection.Methods We enrolled 80 cases of colon cancer receiving left colonic resection in Cangzhou Central Hospital from August 2013 to June 2016 and divided them into the control group and observation group,with 40 cases in each based on the random numbers table.Both groups received the conventional enteral nutrition,the observation group additionally received nutrient enrichment with glutamine. The outcome indexes were compared between two groups,including intestinal permeability indexes〔urinary lactulose/mannitol test(L/M),plasma diamine oxidase(DAO), D-lactic acid,tumor necrosis factor α(TNF-α)〕,nutritional indexes(serum albumin and prealbumin),time needed to recover the bowel sound,duration of hospitalization and rate of infectious complications.Results The values of urinary L/M, plasma DAO,D-lactic acid and TNF-α measured on the 2nd,7th days after surgery were higher than those measured on the day before surgery in both groups(P<0.05).The values of urinary L/M,plasma DAO,D-lactic acid and TNF-α measured on the 7th day after surgery were found to be lower than those measured on the 2nd day after surgery in both groups(P<0.05). The observation group demonstrated lower values of urinary L/M,plasma DAO,D-lactic acid and TNF-α than the control group on the 2nd day as well as the 7th day after surgery(P<0.05).In the control group,the values of albumin and prealbumin measured on the day before surgery were all higher than those measured on the 2nd,7th days after surgery(P<0.05),and the values of albumin and prealbumin measured on the 7th day after surgery were higher than those measured on the 2nd day after surgery(P<0.05).In the observation group,the values of albumin and prealbumin measured on the day before surgery were all higher than those measured on the 2nd day after surgery(P<0.05),and the values of albumin and prealbumin measured on the 7th day after surgery were higher than those measured on the 2nd day after surgery(P<0.05).The observation group presented higher values of albumin and prealbumin than the control group on the 2nd day as well as the 7th day after surgery (P<0.05).The observation group needed shorter time to recover the bowel sound and had shorter duration of hospitalization compared with the control group (P<0.05).The rate of infectious complications in the observation group was lower than that in the control group〔7.5%(3/40)vs 27.5%(11/40)〕(χ2=5.486,P=0.019).Conclusion For patients receiving left colonic resection,nutrient enrichment with glutamine based on the conventional enteral nutrition can maintain the permeability of intestinal mucosa,protect the function of intestinal mucosal barrier and reduce the incidence of infectious complications.