中文摘要：

目的观察全静脉营养加谷氨酰胺（Gln）对危重症患者血浆内毒素（LPS）、肿瘤坏死因子-a（TNF-a）水平及预后的影响。方法将120例危重症患者随机分为观察组和对照组，每组60例。对照组给予常规全静脉营养支持，观察组在对照组全静脉营养支持基础上给予Gln。比较两组患者血浆Gln、LPS和TNF-a水平的变化，以及肠外营养支持治疗时间、住院天数和预后情况。结果观察组血浆Gln水平逐渐升高，与治疗前比较，差异有统计学意义（P〈0．01）。观察组血浆LPS和TNF-a水平逐渐降低，对照组逐渐升高，与治疗前比较，差异均有统计学意义（P〈0．05或P〈0．01）；治疗第3天及第7天两组之间Gln、LPS及TNF—a水平比较，差异均有统计学意义（P〈0．01）。观察组患者肠外营养支持治疗时间和住院天数均显著短于对照组（P〈0．01），感染发生率亦显著低于对照组（P〈0．05）。结论全静脉营养加Gln在危重症患者治疗中可有效改善胃肠道功能，降低血浆LPS和TNF—d水平，改善预后。

英文摘要：

Objective To observe the effects of total parenteral nutrition plus glutamine （Gin） on the level and prognosis of plasma endotoxin （LPS） and tumor necrosis factor-a （TNF-a） in critically ill patients. Methods One hundred and twenty critically ill patients were equally and randomly divided into observation group and control group. The patients in control group were given routine total parenteral nutrition support, while those in observation group were additionally used Gin. The changes of plasma Gln,LPS and TNF-a levels,treatment time of parenteral nutrition support, hospital stays and prognostic condition were compared in two groups. Results The level of plasma Gln up-regulated gradually in observation group,and significantly higher than that before the treatment （P〈0.01）. Plasma LPS and TNF-a levels decreased gradually in the observation group, while increased in the control group,and the changes in both group when compared before and after the treatment were significanty （P〈0.05 and P〈0.01,respectively）. There had a obvious difference in the two groups on 3rd and 7th day of treatment,in the levels of Gin, LPS and TNF-a （P〈0. 01）. And the patients in the observation group had significantly shorter treatment time of parenteral nutrition support and hospital stays （P〈0.01）, and remarkably lower incidence of infection （P〈0.05） than those in control group. Conclusion Total parenteral nutrition plus Gin for critically ill patients can effectively improve the function of gastrointestinal tract, decrease levels of plasma LPS and TNF-a and enhance the prognosis.