不同氮量肠外营养对严重多发伤患者白蛋白水平的影响  

Influence of different nitrogenic parenteral nutrition on albumin level in severe multiple trauma patients

作　　者：余追[1] 严娟娟[1] 张迪[1] 周青山[1] 田建国[1] 

机构地区：[1]武汉大学人民医院重症医学科,430060

出　　处：《临床外科杂志》2013年第12期959-961,共3页Journal of Clinical Surgery

摘　　要：目的 评价不同氮量肠外营养对严重多发伤患者白蛋白水平的影响及其安全性.方法 将严重多发伤且需要实施肠外营养治疗的患者随机分为低氮组（n=21）和正常氮量组（n=19）.两组患者均于入科后第1天开始经中心静脉进行全肠外营养输注,每天给予25 kcal/（kg·d）热卡.低氮组非蛋白氮按0.10 g（0.09 ～0.11 g）/（kg·d）给予,正常氮量组按0.20g（0.18 ～0.22 g）/（kg·d）给予.比较两组患者血清白蛋白浓度、白蛋白用量、利尿剂用量及肝肾功能.结果 肠外营养治疗第7天时正常氮量组患者白蛋白平均值明显高于低氮组（P＜0.05）,该组患者白蛋白用量明显少于低氮量组（P＜0.05）,但其利尿剂用量明显较高（P＜0.05）;两组患者肾功能均正常;肝功能相关指标谷丙转氨酶（ALT）入院后升高,3d后开始下降,且正常氮量组肝功能恢复优于低氮组.结论 充足非蛋白氮的补充可以维持严重多发伤患者血清白蛋白水平,但需要使用利尿剂以避免容量负荷过度.Objective To investigate the safety and influence of different nitrogenic parenteral nutrition （PN）on albumin level in severe multiple trauma patients. Methods Forty severe multiple trauma patients who needed to be supported by PN were divided into hyponitrogen group（ n = 21 ）and normal nitro- gen group（ n = 19）. All patients received central venous PN support on the first day of hospitalization at a dose of 25 kcal/（ kg ~ d）. Hyponitrogen group received at a dose of O. 10 g（O. 09 ~0.11 g）/（ kg ~ d）, and normal nitrogen group received nitrogen at a dose of 0.20 g（ 0.18 - 0.22 g） / （ kg ~ d）. Serum albu- min, human albumin dosage, diuretic consumed and hepatorenal function were compared between the two groups. Results On the 7th day, the mean levels of serum albumin of normal nitrogen group were signifi- cantly higher than that of the hyponitrogen group （ P 〈 0.05 ）. Less human albumins but more diuretics were used in the normal nitrogen group. No dysfunction of kidney was detected for both groups. For hepatic function, the levels of alanine transaminase （ALT） increased in the first 3 days of hospitalization but de- creased later. The recovery of liver function in the normal nitrogen group was better than that of the hyponi- trogen group. Conclusion Adequate doses of non-protein nitrogen in parenteral nutrition support can maintain the serum albumin level in severe multiple trauma patients, however, more diuretics should be needed to avoid cardiac overload.

关 键 词：肠外营养 严重多发伤 白蛋白 

分 类 号：R605[医药卫生—外科学]