门腔分流术后不同氨基酸溶液胃肠外营养的对比研究

目的　评价不同氨基酸溶液胃肠外营养对营养支持效果以及对肝脏功能和血浆氨基酸谱的影响。方法　因门脉高压症住院接受脾切除、限制性门腔静脉侧侧分流术的４０ 例肝功能Ｃｈｉｌｄ Ａ级患者，随机分为两组：Ｈｅｐａ 组和Ｖａｍｉｎ 组，每组各２０ 例。自手术后第１ 天起两组分别接受等氮、等热卡胃肠外营养支持８ 天（Ｈｅｐａ 组以Ｈｅｐａ 氨基酸溶液作为氮源，Ｖａｍｉｎ 组Ｖａｍｉｎ 氨基酸溶液作为氮源）。结果　两组累积氮平衡差异无显著性Ｈｅｐａ；营养支持８ 天后Ｈｅｐａ 组碱性磷酸酶水平显著低于Ｖａｍｉｎ 组（ Ｐ＜０．０５） ；营养支持８ 天后Ｈｅｐａ 组血氨水平显著低于Ｖａｍｉｎ 组（ Ｐ＜ ０－０５） ；Ｈｅｐａ 组血浆支链氨基酸（ＢＣＡＡ） 水平显著高于Ｖａｍｉｎ 组；Ｖａｍｉｎ 组血浆芳香族氨基酸（ＡＡＡ） 水平显著高于Ｈｅｐａ 组；Ｖａｍｉｎ 组血浆蛋氨酸（ＭＥＴＨ） 水平显著高于手术前水平（ Ｐ＜ ０－０１）。Ｈｅｐａ 组ＢＣＡＡ／ＡＡＡ〔（ＶＡＬ＋ ＬＥＵ＋ＩＬＥＵ）／（ＰＨＥ＋ ＴＹＲ）〕显著高于Ｖａｍｉｎ 组（ Ｐ＜ ０－０５）。结论　以Ｈｅｐａ 氨基酸溶液作为氮源可以取得与平衡型氨基酸溶液相似的营养支持效果；对于肝脏功能的损害方面，Ｈｅ

Evaluation of parenteral nutrition with different amino acid solutions after portacaval shunt

Objective To evaluate the nutritional effect of parenteral nutition (PN) with different amino acid solutions on liver function and plasma amino acid pattern in patients received portacaval shunt. Methods Forty portal hypertensive patients (all in Child A) were divided randomly to two groups after performing limited side to side portacaval shunt: Group Hepa received PN with Hepa amino acid solution and Group Vamin received PN with Vamin amino acid solution as the nitrogen source. The PN of same calorie value and same nitrogen content for both groups was used begun on the first day after operation and continued for the next 8 days. Results (1) The cumulative nitrogen balance of the two groups was not significantly different; (2) The AKP in Group Hepa was significantly lower than that in Group Vamin (P<0.05); (3)The blood level of ammonia in Group Hepa was significantly lower than that in Group Vamin (P<0.05); (4)The plasma BCAA level in Group Hepa was significantly higher and the plasma AAA level was significantly lower in Group Hepa than those in Group Vamin, respectively. The plasma METH level of Group Vamin was significantly higher than that before nitrogen support, and the ratio of (Val Leu ILEU)/(PHE TYR) in Group Hepa was significantly higher than that in Group Vamin. Conclusions (1)The use of Hepa solution as the nitrogen source could achieve the same effect as using balanced amino acids; (2)The liver damage by Hepa solution was milder than that by Vamin solution; (3) Compared with balanced amino acids, the use of Hepa solution after portacaval shunt could increase BCAA level, decrease AAA and METH levels, and make the amino acid pattern more reasonable. These advantages for plasma amino acids would prevent the postshunt encephalopathy.