支链氨基酸对全胃切除术后肠外营养影响的前瞻性研究

Effect of branched-chain amino acid on total parenteral nutritional support in patients after total gastrectomy: A prospective study

目的：研究富含支链氨基酸（BCAA）的复方氨基酸制剂对全胃切除术后的营养支持效果．方法：全胃切除术患者40例，随机分成两组，每组20例．术后1～7d行等氮、等热量全胃肠外营养支持．103g／L的高支链复方氨基酸注射液（含BCAA359g／kg），对照组应用104g／L的复方氨基酸注射液（含BCAA218g／kg）．术后1～7d每天收集24h尿液测定氮量，并计算氮平衡．手术前、术后3d、术后7d测量体质量、双手握力、三头肌皮褶厚度、上臂围以及静脉血总蛋白、白蛋白、前白蛋白、转铁蛋白、C．反应蛋白．结果：研究组术后第2d即转为正氮平衡，对照组术后第6d才开始转正，第3d时，两组之间的差异具有显著性（P〈0．01）；术后第7d，研究组双手握力明显高于对照组（P〈0．05）；术后第7d，研究组血浆前白蛋白、转铁蛋白浓度明显高于对照组（P〈0．01）．结论：全胃切除术后应用含较高BCAA的营养液更有利于患者恢复，改善预后．

AIM： To investigate the effect of branched-chain amino acid （BCAA） enriched solution on total parenteral nutritional support in patients after total gastrectomy. METHODS： Forty patients who underwent total gastrectomy were enrolled in the prospective, randomized and single-blindcontrolled study, and were randomized to receive total parenteral nutrition （ TPN ） with either BCAA enriched solution （ n = 20, experiment group） or amino acid solution（18-F） （n = 20, control group）. TPN was infused to all patiens with equal calorie and equal nitrogen by central or peripheral vein during the immediate 7 d after operation. Meanwhile, nitrogen balance was monitored by collecting 24-h urine for 7 d. The indices were investigated such as the body weight, hand grip strength, triceps skin-fold thickness, upper ann circumference, serum levels of total protein, albumin, prealbumin, transferrin, and C-reactive protein before and after operation. RESULTS： The positive nitrogen balance in the experimental group was got on the 2nd postoperative day, 4 d earlier than that in the control group, and the levels of nitrogen balance on the 3rd postoperative day were varied significantly between the 2 groups （ P 〈 0.01 ）. After 7-d TPN, the hand grip strength （ P 〈 0.05 ）, serum levels of prealbumin （ P 〈 0.01 ）, and transferrin （P 〈0.01 ） in the experimental group increased more significantly than those in the control group. CONCLUSION： The BCAA enriched solution can improve the nutritional status and achieve favorable prognosis in the patients receiving total gastrectomy.