不同平衡氨基酸对严重腹部创伤患者术后营养代谢及预后的影响  

Effects of Different Equilibrium Amino Acid on Nutrition Metabolism after Surgery and Prognosis of Severe Abdominal Trauma Patients

作　　者：郑姣妮[1] 向江侠[2] 张颖[1] ZHENG Jiaoni;XIANG Jiangxia;ZHANG Ying(Dept. of Pharmacy,Chongqing Emergency Medical Center,Chongqing 400014, China;Dept. of Traumatology, Chongqing Emergency Medical Center, Chongqing400014,China)

机构地区：[1]重庆市急救医疗中心药剂科,重庆400014 [2]重庆市急救医疗中心创伤科,重庆400014

出　　处：《中国药房》2018年第10期1364-1368,共5页China Pharmacy

基　　金：重庆市卫生和计划生育委员会医学科研计划项目(No.渝卫科教发[2016]53号-2016MSXM078)

摘　　要：目的:比较平衡氨基酸和富含支链氨基酸的平衡氨基酸对严重腹部创伤患者术后营养代谢及预后的影响。方法:选取我院2016年9月-2017年6月严重腹部创伤患者60例,按区组随机化方法分为A、B组,各30例。两组患者均在手术和术后常规治疗的基础上给予等氮、等热量的肠外营养支持治疗,其中A组给予8.5%复方氨基酸注射液(18AA-Ⅱ),B组给予10%复方氨基酸注射液(20AA);氨基酸给予量均为1.2 g/(kg·d),每日输注时间不少于12 h。两组患者的疗程均为7 d。观察两组患者治疗前后的氮平衡、血清蛋白(总蛋白、白蛋白、前白蛋白、转铁蛋白)水平和血浆氨基谱,比较其住院时间、生存率以及并发症和不良反应的发生情况。结果:A组有2例、B组有1例患者中途出院,共有57例完成本研究。治疗前,两组患者的氮平衡水平、血清蛋白水平和血浆氨基谱比较,差异均无统计学意义(P>0.05)。治疗后,B组患者的累计氮平衡水平显著优于A组;B组患者治疗后第3~7天、A组患者治疗后第5~7天的氮平衡水平均显著上升,且从治疗后第4天起,B组患者的氮平衡水平均显著优于A组,差异均有统计学意义(P<0.05)。A组患者的白蛋白、前白蛋白、转铁蛋白水平均显著下降,且显著低于B组,差异均有统计学意义(P<0.05)。两组患者的甘氨酸、苏氨酸水平均显著上升;B组患者的精氨酸水平显著下降,缬氨酸、支链氨基酸水平显著上升,且分别显著低于或高于A组,差异均有统计学意义(P<0.05)。B组患者胃肠道并发症、切口裂开的发生率及并发症的总发生率均显著低于A组,差异均有统计学意义(P<0.05);两组患者的住院时间、生存率及感染的发生率比较,差异均无统计学意义(P>0.05)。两组患者均未见明显不良反应发生。结论:相较于平衡氨基酸,富含支链氨基酸的平衡氨基酸可进一步改善和维持严重腹部创伤患者术后的氮平衡、血清�OBJECTIVE：To compare the effects of equilibrium amino acid and it rich in branched chain amino acid on nutrition metabolism after surgery and prognosis of severe abdominal trauma patients. METHODS：A total of 60 severe abdominal trauma patients selected from our hospital during Sept. 2016-Jun. 2017 were divided into group A and B according to block randomization,with 30 cases in each group. Both groups were all given iso nitrogenous and iso caloric parenteral nutrition support on the basis of surgery and routine treatment after surgery;group A was additionally given 8.5% Compound amino acid injection（18 AA-Ⅱ）1.2 g/（kg·d）for 12 h each day at least;group B was additionally given 10% Compound amino acid injection（20 AA）1.2 g/（kg·d）for 12 h each day at least. Both groups were treated for 7 d. The levels of nitrogen balance and serum protein（total protein,albumin,prealbumin and transferrin）,plasma amino spectrum were observed in 2 groups before and after treatment.Hospitalization time,survival rate,the occurrence of complication and ADR were compared between 2 groups. RESULTS：Two patients of group A and one patient of group B were discharged,and totally of 57 patients completed the study. Before treatment,there was no statistical significance in the levels of nitrogen balance,serum protein or plasma amino spectrum（P〈0.05）. After treatment,the cumulative nitrogen balance of group B was significantly better than that of group A. The level of nitrogen balance was increased significantly in observation group 3-7 d after treatment and control group 5-7 d after treatment. Since 4 d after treatment,the level of nitrogen balance in group B was significantly better than control group,with statistical significance（P〈0.05）. The levels of albumin,prealbumin and transferring in group A were decreased significantly,and were significantly lower than group B,with statistical significance（P〈0.05）.The levels of glycine and threonine in 2 groups were increased significantly. The level of ar

关 键 词：平衡氨基酸 支链氨基酸 严重腹部创伤 营养代谢 预后 影响 

分 类 号：R605.979[医药卫生—急诊医学]