• 1. 四川大學(xué)華西醫(yī)院ICU（成都 610041） 2. 四川大學(xué)華西醫(yī)院普外科3. 四川大學(xué)華西醫(yī)院呼吸科;

目的 　研究補充外源性谷氨酰胺雙肽對慢性阻塞性肺?。–OPD）合并呼吸衰竭重癥患者的胰島素抵抗及臨床結(jié)局的影響。
方法 　隨機對照試驗設(shè)計。選取2005 年 1 月至 2006 年 2 月入住四川大學(xué)華西醫(yī)院ICU 的 COPD 合并呼吸衰竭重癥患者30 例，隨機分為兩組。試驗組（n=14）給予谷氨酰胺增強的腸外營養(yǎng)，對照組（n=16）接受等氮等熱量的腸外營養(yǎng)。在治療的第3 及第5 天對兩組進行血糖鉗閉，嚴(yán)格控制血糖在4.4 ～ 6.1 mmol/L。觀察兩組患者每天的呼吸功能變化、血糖水平、胰島素使用量以及30 天病死率、帶呼吸機時間、 ICU 住院時間、住院時間及費用等情況。
結(jié)果 　兩組病例全部完成試驗。試驗組與對照組比較，呼吸功能變化無明顯差異。試驗組 5 天的血糖平均值有降低的趨勢，5 天的總體平均胰島素用量明顯下降。兩組30 天病死率、住ICU 院時間及費用差異均無統(tǒng)計學(xué)意義，但試驗組的住 ICU 時間，帶呼吸機時間有縮短的傾向。
結(jié)論 　谷氨酰胺對于 COPD 合并呼吸衰竭重癥患者的呼吸功能無明顯的影響，但在降低其胰島素抵抗、穩(wěn)定血糖水平方面有一定的作用。谷氨酰胺對于COPD合并呼吸衰竭重癥患者 30 天病死率、ICU 住院時間、ICU 費用及住院總費用上無明顯影響，但在ICU住院時間，帶呼吸機時間上有縮短的傾向。

引用本文： 強新華,江華,金曉東,康焰,易群. 谷氨酰胺雙肽對慢性阻塞性肺病合并呼吸衰竭重癥患者胰島素抵抗及臨床結(jié)局的影響. 中國循證醫(yī)學(xué)雜志, 2007, 07(9): 645-649. doi: 復(fù)制

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  1. 1. Douglas W. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr, 2001, 131 (9 Suppl): 2543-2549.
  2. 2. 黎介壽. 危重病人與免疫營養(yǎng).腸外與腸內(nèi)營養(yǎng), 2001, 8(3): 127-128 .Li JS. Critical patients and immuno－nutrition.Parenteral & Enteral Nutrition, 2001, 8(3): 127-128 .
  3. 3. Ferreire IM, Brooks D, Lacasse Y, et al. Nutritional support for individuals with COPD: a meta-analysis. Chest, 2000, 117(3): 672-678.
  4. 4. Opara EC, Petro A, Tevrizian A, et al. L-glutamine supplementation of a high fat diet reduces body weight andattenuates hyperglycemia and hyperinsulinemia in C57BL/6J mice. J Nutr, 1996, 126(1): 273-279.
  5. 5. Laird AM, Miller PR, Kilgo PD, et al. Relationship of early hyperglycemia to mortality in trauma patients. JTrauma, 2004, 56(5): 1058-1062.
  6. 6. Andersen SK, Gjedsted J, Christiansen C, et al. The role of insulin and hyperglycemia in sepsis pathogenesis. J Leukoc Biol, 2004, 75(3): 413-421.
  7. 7. Bastian L, Weimann A. Immunonutrition in patients after multiple trauma. Br J Nutr, 2002, 87(Suppl): 133-134.
  8. 8. Griffiths RD, Allen KD, Andrews FJ, et al. Infection, multiple organ failure,, and survival in the intensive care unit:　Influence of glutamine-supplemented parenteral nutrition on acquired infection. Nutrition, 2002, 18(7-8): 546-552.
  9. 9. Bakalar B, Duska F, Pachl J, et al. Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple- -trauma patients. Crit Care Med, 2006, 34(2): 381-386.