富含支链氨基酸的肠外营养液在外科危重病人中的应用

Parenteral administration of branch-chain amino acids enrichment in critically ill surgical patients.

目的研究富含支链氨基酸的肠外营养液对危重病人营养状况和临床转归的影响。方法按随机、对照、单盲的原则,将2003年10月至2004年4月入住中山大学第一附属医院SICU,符合入选标准的40例病人分为研究组和对照组,两组使用等热量、等氮量的全肠外营养(TPN),检测血浆氨基酸谱的变化和测定氮平衡。结果治疗后,研究组缬氨酸、亮氨酸、异亮氨酸和精氨酸的浓度较对照组显著提高(P=0.008,P=0.02,P=0.01,P=0.007)。治疗后两组均未达到正氮平衡,但研究组显示出较对照组更快达到正氮平衡的趋势。治疗后研究组APACHⅡ评分较对照组下降更为明显(P<0.01)。两组平均住院时间和病死率差异无显著性(P>0.05)。结论富含支链氨基酸的肠外营养液可改善危重病人血浆氨基酸谱的构成,促进蛋白质合成,抑制蛋白质分解;大样本的研究有助于评估支链氨基酸对危重病人临床转归的影响。

Objective To investigate the effect of the infusion of BCAA-enriched parenteral nutrition in critical patients on nutritional status and clinical outcome.Methods 40 critical patients who met the criteria were enrolled in a prospective,randomly and single-blind-controlled study,and received total parenteral nutrition.TPN was infused to the patients in both groups with equal calorie and equal nitrogen by central vein.Meanwhile,plasma amino acid patterns and nitrogen balance were assayed.Results After 6 days treatment of parenteral nutrition, plasma concentrations of valine(P=0.008),leucine(P=0.02) and isoleucine(P=0.01) in research group increased more obviously than that in control group, so did the plasmaconcentrations of arginine(P=0.007).No positive nitrogen balance was obtained after 6 days’treatment of parenteral nutrition in the two groups.APACHEⅡscores of research group decreased more obviously than that of control group,but length of stay and mortality rate show no significant differences between the two groups. Conclusion The formula of amino acid enriched BCAA may normalize the levels of serum amino acids,reduce the proteolysis,and increase the synthesis of protein.A further study with large sample is important to evaluate the effect of BCAA on clinical outcome in critically ill patients.