支链氨基酸对创伤后代谢影响的研究

Metabolic effects of administration of branched chain amino acids on postoperative patients

目的 :观察应用支链氨基酸对手术创伤病人机体代谢的影响。 方法 :采用前瞻、随机、单盲、平行、对照、多中心试验设计 ,选择行腹部外科手术后成年病人 1 2 0例 ,随机分为两组 :对照组 (n =6 0 )应用 1 0 .4 % 1 8种复方氨基酸注射液 ,研究组 (n =6 0 )应用 1 0 .3%支链氨基酸注射液。采用全营养混合液方式行周围或中心静脉输注 ,等氮等热量。从术后第 2天开始 ,应用 6天。在手术前 1天和术后第 7天 ,对所有病人收集空腹血标本检测 ,同时进行 2 4h尿液收集作氮平衡分析。 结果 :研究组与对照组之间在研究前、后累积氮平衡无明显差异 ,但在营养液输注第 5天 ,研究组氮平衡显著高于对照组 (P <0 .0 1 )。两组之间研究前、后血清总蛋白、前清蛋白、纤维连接蛋白、转铁蛋白和体重变化无显著差异。两组研究前、后血清清蛋白浓度均降低 ,但对照组下降更为明显 (P <0 .0 5 )。研究组应用氨基酸后 ,缬氨酸浓度升高明显 ,与对照组相比差异显著 (P <0 .0 5 )。缬氨酸、丙氨酸和支链氨基酸浓度较输注前明显升高 (P <0 .0 5 )。 结论 :对手术创伤应激病人的肠外营养支持中 。

Objective: To investigate the metabolic effects of two different formula of amino acids on postoperative patients . Methods: According to prospective ,randomized , single blind and controlled rule, 120 patients after abdominal operation were randomized to receive parenteral nutrition with either amino acid enriched BCAA or balanced amino acid (18 F).From the second day after operation, total parenteral nutrition was infused to the patients with equal calorie and equal nitrogen by central or peripheral vein for 6 days. Meanwhile, every day nitrogen balance was monitored by collecting urine in 24 hours .The indices were investigated such as amino acids patterns, and serum levels of total protein, albumin, prealbumin, thansferrin and fibronectin. Results: Nitrogen balance of patients in study group on day5 was higher than those of control group. The decreased serum levels of albumin in study group were lower than the control group. Concentrations of valine increased more significantly in study group than that of the control group. Conclusions: The formula of amino acid enriched BCAA may be more suitable and effective for the postoperative traumatic patients on protein metabolism.