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目的:探讨大剂量丙氨酰谷氨酰胺(Ala-Gln)在上消化道穿孔合并脓毒血症患者中的疗效。方法:纳入90例上消化道穿孔合并脓毒血症患者,随机分为常规剂量Ala-Gln治疗组(对照组)和大剂量Ala-Gln治疗组(实验组),2组患者均予上消化道穿孔修补术、液体复苏、血管活性药物、抗生素、全肠外营养(TPN)等治疗;TPN中添加Ala-Gln方面,对照组使用Ala-Gln(0.4 g/kg/d),实验组使用Ala-Gln(0.8 g/kg/d),均使用7天;观察2组急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)、血管活性药物使用时间、入院第7天血乳酸水平、抗生素使用时间、腹腔引流管保留时间、机械通气时间、ICU住院时间、28天死亡率。结果:实验组入院第7天血乳酸水平、抗生素使用时间、腹腔引流管保留时间、机械通气时间均有显著降低,差异均有统计学意义(P<0.05);实验组血管活性药物使用时间有减少,但两组差异无统计学意义(P>0.05);实验组ICU住院时间、28天死亡率显著下降,差异均有统计学意义(P<0.05)。结论:大剂量Ala-Gln治疗可促进休克状态纠正,促进感染控制,降低炎症反应程度,缩短ICU住院时间,降低28天死亡率。
Objective: To investigate the efficacy of high-dose alanyl-glutamine (Ala-Gln) in patients with upper gastrointestinal perforation complicated with sepsis. Methods: Ninety patients with upper gastrointestinal perforation complicated with sepsis were enrolled and randomly divided into conventional Ala-Gln treatment group (control group) and high-dose Ala-Gln treatment group (experimental group) In the TPN, Ala-Gln was added, Ala-Gln (0.4 g / kg / d) was used as the control group, while the experimental group was used as the experimental group Ala-Gln (0.8 g / kg / d) for 7 days. The acute physiology and chronic health score Ⅱ (APACHE Ⅱ), vasoactive drug use time, blood lactic acid level on the 7th day, antibiotic use time, Abdominal drainage tube retention time, mechanical ventilation time, ICU hospitalization time, 28-day mortality. Results: The blood lactate level, antibiotic use time, retention time of abdominal drainage tube and mechanical ventilation time of the experimental group on the 7th day after admission were all significantly decreased (P <0.05). The duration of vasoactive drug use in the experimental group was (P> 0.05). The ICU hospitalization time and the 28-day mortality in the experimental group were significantly decreased, the differences were statistically significant (P <0.05). Conclusion: High-dose Ala-Gln therapy can improve the state of shock, promote infection control, reduce the degree of inflammatory reaction, shorten the hospital stay of ICU and reduce the 28-day mortality.