透析中肠外营养对血液透析患者营养状况的影响

目的评估透析中肠外营养作为营养不良血液透析患者的营养干预措施的有效性和安全性。方法本试验采用前瞻性、随机、对照试验方法,选择暨南大学第四附属医院肾内科36例患者随机分为三组①对照组,②50%葡萄糖干预组,③8.5%氨基酸干预组,试验前后测量营养状况指标及其他生化指标。结果①干预前后比较,葡萄糖和氨基酸干预组的营养指标升高,尤以血清前白蛋白（PA）、血清转铁蛋白（TRF）、蛋白分解率（PCR）升高明显,具有统计学意义（P〈0.05）;②50%葡萄糖干预组干预后谷氨酸、色氨酸和亮氨酸水平明显提高,具有统计学意义（P〈0.05）,8.5%氨基酸干预组干预后谷氨酰胺、苏氨酸、酪氨酸、缬氨酸、苯丙氨酸、亮氨酸、必需氨基酸以及总氨基酸的水平均明显提高,具有统计学意义（P〈0.05）;③三组患者干预前后的三酰甘油、胆固醇、低密度脂蛋白以及C反应蛋白均没有统计学意义（P〉0.05）。结论透析中肠外营养干预可以提高血液透析患者营养状况,也可以改善患者的血清氨基酸状态,但不会影响患者炎症状况和引起血脂的升高。

Effect of intradialytic parenteral nutrition on nutrition status of hemodialysis patients

Objective To assess the safety and efficacy of intradialytic parenteral nutrition （IDPN） as a nutritional support measure in malnourished hemodialysis patients. Method We prospectively and randomly assigned 36 patients into 3 groups： control group, patients treated with 50% glucose （glucose group）, and those treated with 8.5% amino acid preparation （amino acid group）. They were followed up for 4 weeks, and their nutritional and other biochemical parameters were collected before and after the treatment. Results （i） In the glucose group and amino acid group, nutritional status improved after the treatment, demonstrating the higher serum prealbumin and transferrin, and protein catabolic rate than those of control group （P 〈 0.05）. （ii） In the glucose group, serum glutamic acid, tryptophan and leucine increased significantly （P 〈 0.05）. In the amino acid group, serum glutamine and tyrosine, the essential amino acids of threonine, valine, phenylalanine and leucine, and the total amino acids amount increased significantly （P 〈 0.05）. （iii） Serum triglycerides, cholesterol, low density lipoprotein and C- reactive protein remained unchanged in the 3 groups （P 〉 0.05）. Conclusion IDPN improves the nutritional status in hemodialysis patients with the increase of their serum amino acids, but IDPN does not induce inflammatory status and the increase of serum lipids. Therefore, IDPN is a safe and effective measure to improve the nutritional status of malnourished hemodialysis patients.