支链氨基酸对全胃切除术后肠外营养影响的前瞻性研究

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1～7 d行等氮、等热量全胃肠外营养支持. 103 g/L的高支链复方氨基酸注射液(含BCAA 359 g/kg),对照组应用104 g/L的复方氨基酸注射液(含BCAA 218 g/kg). 术后1～7 d每天收集24 h尿液测定氮量,并计算氮平衡. 手术前、术后3 d、术后7 d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2 d即转为正氮平衡,对照组术后第6 d才开始转正,第3 d时,两组之间的差异具有显著性(P＜0.01);术后第7 d,研究组双手握力明显高于对照组(P＜0.05);术后第7 d,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.

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

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-blind- controlled 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 arm 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.