胃大部切除术后不同浓度支链氨基酸液的应用

胃大部切除术后和其它手术、创伤病人一样,术后短期内体内能源物质(如糖、脂肪酸等)被动用,肌肉蛋白分解代谢加速,使机体处于负氮平衡。同时,血浆氨基酸(AA)谱也发生改变。近年来的研究证明,支链氨基酸(BCAA)不仅可提供肌肉能量代谢的底物,而且还有氮保存作用。本文对胃大部切除术后病人使用不同浓度BCAA的AA液治疗,观察了对氮平衡和血浆AA谱的影响。

APPLICATION OF VARIOUS CONCENTRATIONS OF BRANCHED CHAIN AMINO ACID SOLUTIONS FOR SUB-TOTAL GASTRECTOMY

Forty patients who underwent sub-total gastrectomy were divided into four groups, one of them for comparison, the other three groups received 10%, 30% and 100% branched-chain amino acid (BCAA) respectively. The results showed that in BCAA-10 and BCAA-3H group, negative balance was partially corrected, but in BCAA-10 group nitrogen remained an obvious negative balance on the 3rd postoperative day. There were more than ten of plasma AA lower than preoperative day in these two groups. In BCAA-30 group, after surgery, negative nitrogen balance was significantly corrected, and changes of plasma AA had no statistic significance compared with that before operation.Creatinine of urine had no significant difference between each group.In BCAA-30 group, transferrin (Tf) was increased compared with that before operation. It is suggested that the protein synthesis is corrected but the catabolism is not restrained.BCAA may play a regulatory role in muscle protein metabolism, BCAA can serve as fuel substrate to promote synthesis and reduce breakdown of muscle protein to correct negative nitrogen balance.Application of large quantities of BCAA should be based on isotonic AA solution.