Effects Of Different Concentrations Of Alanyl Glutamine In PN On Postoperative Patients With Gastric And Colorectal Carcinoma

Background: Parenteral nutrition(PN)refers to the delivery of nutrients to the body by means other than the gastrointestinal tract,and is an important way to provide nutritional support for patients with gastric cancer,colorectal cancer and other severe diseases that cannot be taken orally after surgery.Reasonable proportion of PN prescription is of great significance to ensure patient safety and promote prognosis.Glutamine is the most abundant amino acid in the body,and it is a necessary amino acid for the body.It needs to be supplemented when the body is in surgical trauma and systemic inflammatory reaction.Alanyl glutamine(Ala-Gln)can be hydrolyzed into glutamine,which is the main way of clinical supplementation of glutamine.Ala-Gln is a high concentration solution that cannot be directly injected and must be compatible with a certain volume of amino acid carrier solution.However,the proportion of Ala-Gln in total amino acids is different in drug instructions at home and abroad,and the use of off-label dosage is common in clinical practice.Objective: To analyze the rationality of parenteral nutrition prescription in the general surgery department of our hospital,and to deeply understand the use of Ala-Gln in our hospital,so as to provide data support for clinical research.A clinical study was conducted to explore the effects of low-dose group(Ala-Gln accounted for 20% of all amino acids)and high-dose group(Ala-Gln accounted for 30% of all amino acids)on postoperative nutrition,liver and kidney functions,immune levels,postoperative infection complications,postoperative hospital stay and hospitalization costs in patients with gastrointestinal tumors.Methods: Parenteral nutrition prescriptions were collected from the department of General Surgery,Xiangya Hospital,Central South University from January 2020 to January 2021.The prescriptions were analyzed according to the evaluation principle,and the analysis results were described by constituent ratio(%).A randomized controlled clinical trial was conducted to include patients admitted to Xiangya Hospital of Central South University for gastrointestinal surgery and gastric and intestinal tumor surgery.Patients were given PN support [fatty milk amino acid(17)glucose(11%)injection(1440ml)],biochemical indicators were monitored before surgery,1 day after PN ended,and 1day after surgery,and information about postoperative infection,postoperative hospitalization time and hospitalization expenses were collected systematically in the hospital.Results: 1.The analysis of parenteral nutrition prescriptions in general surgery department showed that the prescriptions were mainly distributed in gastrointestinal surgery department,hepatobiliary and pancreatic surgery department.The utilization rate of Ala-Gln exceeding specification dose(20% of all amino acids)was up to 98.4%.In addition,there were low sugar to lipid ratio(76.8%)and low amino acid concentration(41.4%).The cationic concentration met the standard,and no other drugs were added to parenteral nutrition.2.Clinical trial results showed that high dose group(Ala-Gln accounted for 30% of total amino acid)and low dose group(Ala-Gln accounted for 20% of total amino acid)had no significant effect on prealbumin;The helper T cells in the high dose group were higher than the inhibitory T cells(Th/Ts)in the low dose group(P =0.03),and the immune regulation of T cells was better than that of the low dose group.The two groups had no significant influence on liver and kidney function,incidence of postoperative infection and complications,postoperative hospitalization time and hospitalization cost.Conclusions: 1.The prescription of parenteral nutrition in the general department of surgery in our hospital is unreasonable,which requires clinical pharmacists to strengthen prescription review and rational drug use intervention.2.The high-dose group(Ala-Gln accounts for 30% of total amino acids)has better immune regulation of T lymphocytes,and appropriate amino acid preparations should be selected based on patients’ conditions in clinical practice.