回溯性分析外科手術重症病患使用全靜脈營養併用L-Alanyl-L-glutamine Dipeptide治療之臨床效益

A Retrospective Analysis:The Clinical Benefits of Total Parenteral Nutrition Supplemented with L-Alanyl-L-glutamine Dipeptide for Surgical Intensive Care Unit Patients

鄭育凌(Yu-Ling Cheng)

指導教授 ： 顏銘宏

高雄醫學大學/藥學院/藥學研究所/碩士(2012年)

摘要

背景：本研究進行了回顧性分析研究，評估實施外科手術之重症住院病患（Surgical intensive care unit；SICU），使用全靜脈營養（Total Parenteral Nutrition；TPN）併用L-Alanyl-L-glutamine dipeptide　（Dipeptiven®；Aln-Gln）治療，對於免疫功能、免疫營養指標與臨床療效之影響。

方法：本研究於南部某區域教學醫院進行，經系統性篩選2008年1月到2010年12月間，選擇使用全靜脈營養（TPN）溶液≧7天之外科手術重症住院病患，在排除肝、腎功能不良、懷孕及授乳、及有酸代謝情形之後，分成全靜脈營養組（TPN組）及全靜脈營養添加Aln-Gln組（TPN + Aln-Gln組），以回溯性病歷回顧方式分析兩組間之免疫功能、免疫營養指標與臨床療效之差異。

結果：本研究總共收錄354位外科手術之重症住院病患，經排除相關條件後，有118位病患納入分析，分成兩組：全靜脈營養組（TPN組）
65位、全靜脈營養添加Aln-Gln組（TPN + Aln-Gln組）53位。兩組患者在臨床特徵，性別，年齡，身高和體重方面的比較無顯著差異
（P＞0.05）。兩組患者在手術7天後免疫球蛋白（IgA、IgG、IgM） 的比較，TPN + Aln-Gln組在IgA及IgM的表現與TPN組比較有顯著提升（P＜0.05），IgG的表現沒有影響（P＞0.05）；在免疫營養指標albumin、transferrin和prealbumin濃度的表現，TPN + Aln-Gln組在albumin、transferrin和prealbumin濃度的表現與TPN組比較，三者均有顯著提升（P＜0.05）；在C-反應蛋白（C-Reactive Protein；CRP）濃度的表現，TPN + Aln-Gln組與TPN組比較有顯著降低（P＜0.05）。

結論：使用全靜脈營養（TPN）併用L-Alanyl-L-glutamine dipeptide （Dipeptiven®）療法與單獨使用全靜脈營養（TPN）相比較，併用L-Alanyl-L-glutamine dipeptide能明顯改善外科手術重症住院病患手術後的免疫營養指標功能，提升免疫功能，降低發炎指數，對患者手術後的臨床效益評估，具有實質的提升效益。

關鍵字

外科手術之重症住院病患 ； 全靜脈營養 ； 免疫功能 ； 免疫營養指標 ； C-反應蛋白 ； L-Alanyl-L-glutamine dipeptide

並列摘要

Background: The study conducted a retrospective analysis of total parenteral nutrition(TPN) and/or supplemented with L-alanyl-L-glutamine dipeptide(Dipeptiven®; Aln-Gln) on surgical intensive care unit(SICU) patients to evaluate the benefit of immune activity, immunonutrition changes and clinical outcomes.

Methods: The clinical data were collected from a regional teaching hosipital in South Taiwan during January 2008 to December 2010 under IRB approvement. All experimental subjects received TPN continuously more than 7 days were allocated equally into two groups, one is TPN group received regular TPN only, the other is TPN+Aln-Gln group received TPN supplemented with Aln-Gln. The benefit of immune activity, immunonutrition changes and clinical outcomes in these two groups were performed retrospectively with medical record review.

Results: 354 patients were included in this study. Under exclusive condition(glutamine allergy; pregnancy or lactation; renal and/or liver dysfunction; severe metabolic acidosis), 118 patients were inclusive of this study. All experimental subjects were allocated into two groups, 65 cases in TPN group and 53 cases in TPN+Aln-Gln group. These two groups were no differences in terms of clinical charcteristics, gender, age, height and body weight (p＞0.05). After seven days of surgery, the IgA and IgM levels of TPN+Aln-Gln group were significantly increased when compared to TPN group (P＜0.05), while IgG was no different in these two groups. In immunonutritional target of albumin, prealbumin and transferrin, TPN+Aln-Gln group were significantly increased when compared to TPN group (P＜0.05). In C-reactive protein(CRP) concentration, TPN+Aln-Gln group was significantly reduced when compared to TPN group (P＜0.05).

Conclusions: Using total parenteral nutrition(TPN) supplemented with L-alanyl-L-glutamine dipeptide(Dipeptiven®; Aln-Gln) on surgical intensive care unit(SICU) patients was a great improvement on the increasing availability of immune function and immunonutrition when compared to using TPN only. Furthermore, it also can reduce C-reactive protein concentration. These results suggested that using total parenteral nutrition(TPN) supplemented with L-alanyl-L-glutamine dipeptide (Dipeptiven®; Aln-Gln) on surgical intensive care unit patients was more clinical benifts than using TPN only.

並列關鍵字

Surgical intensive care unit ； total parenteral nutrition ； immune function ； immunonutrition ； C-reactive protein ； L-alanyl-L-glutamine dipeptide.

參考文獻

參考文獻

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