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目的:探讨丙氨酰谷氨酰胺(Ala-Gln)在高龄重症肺炎患者治疗中的作用。方法:56例医院获得性重症肺炎的高龄患者,随机分成应用丙氨酰谷氨酰胺(Ala-Gln)组30例和对照组26例,对照组给予抗感染、营养支持、对症治疗等常规治疗,Ala-Gln组在此基础上,给予丙氨酰谷氨酰胺10g加入复方氨基酸250ml中,ivd bid,共14d。治疗前后分别对两组患者进行肠功能评分,测定血清白蛋白(Alb)、免疫球蛋白(IgG)、总淋巴细胞计数、C反应蛋白(CRP)、氮平衡,肝功能、肾功能。结果:治疗后两组患者肠功能评分比较差异有统计学意义(P<0.01);C反应蛋白(CRP)与APACHEⅡ评分两组均有下降(P<0.05),Ala-Gln组较对照组下降更为明显(P<0.05)。Ala-Gln组肺炎平均治愈好转时间为(19±3)d,较对照组(26±4)d明显缩短。结论:高龄重症肺炎患者及时补充丙氨酰谷氨酰胺,可减少有害或过度的炎症反应,维持正常肠粘膜屏障功能及正常免疫反应,有效防治肠功能衰竭,有利于肺炎的控制,从而提高救治率。
Objective: To investigate the role of alanyl-glutamine (Ala-Gln) in the treatment of elderly patients with severe pneumonia. Methods: A total of 56 elderly hospitalized patients with severe pneumonia were randomly divided into three groups: 30 patients in the Ala-Gln group and 26 patients in the control group. The patients in the control group were given anti-infection, nutritional support and symptomatic treatment , Ala-Gln group on this basis, given alanyl glutamine 10g compound amino acid 250ml, ivd bid, a total of 14d. Before and after treatment, the intestinal function scores of two groups were respectively measured, and serum albumin (Alb), immunoglobulin (IgG), total lymphocyte count, C-reactive protein (CRP), nitrogen balance, liver function and renal function were measured. Results: There was significant difference in the scores of intestinal function between the two groups after treatment (P <0.01). The CRP and APACHEⅡscores decreased in both groups (P <0.05), while those in Ala-Gln group decreased More obvious (P <0.05). The average healing time of pneumonia in Ala-Gln group was (19 ± 3) d, which was significantly shorter than that in control group (26 ± 4) d. Conclusion: Acute severe pneumonia in patients with alanine glutamine supplementation can reduce the harmful or excessive inflammatory response, maintaining normal intestinal mucosal barrier function and normal immune response, effective prevention and treatment of intestinal failure, is conducive to the control of pneumonia, thereby enhancing the treatment rate.