Berneis K, Iseli-Schaub J, Garbani E, Meier R, Kiss D
Department of Internal Medicine, University Hospital Liestal, Switzerland.
Wien Klin Wochenschr. 1999 Nov 12;111(21):876-81.
Protein and calorie malnutrition is frequently observed in chronic haemodialysis (HD) patients. Recently it has been suggested that intradialytic nutritional support with amino acids may improve nutritional status and increase immunocompetence. The aim of this study was to evaluate the effects of intradialytic infusion of amino acids, lipids and glucose on body composition and other parameters of nutritional status in patients undergoing HD.
Seven patients with a mean age of 77 +/- 6 years (range, 60-86 years), a mean BMI of 20.1 +/- 2.8 (range, 16.1-24.4) and clinical signs of malnutrition participated in the study (mean time on HD, 51 +/- 36 months). HD was performed 12 hours per week with bicarbonate as a buffer and a polysulfon capillary dialyzer (F-60). During the 3-month period of intervention the patients received an intradialytic parenteral solution during the regular scheduled dialysis treatment, containing amino acids (12 g s/h), a glucose 15% solution (37.5 g/h) and a fat emulsion (12.5 g/h).
(mean +/- SEM) Total calorie intake increased from 1550 +/- 63 to 2255 +/- 114 (kcal/24 h) p < 0.01, during the intervention period and body weight increased from 49.9 +/- 5.9 to 51.9 +/- 5.7 kg (p < 0.005). Fat mass and lean body mass (bioelectrical impedance analysis, BIA) increased from 13.2 +/- 2.6 to 14.2 +/- 2.6 (p < 0.02) and from 36.9 +/- 3.2 to 37.9 +/- 3.2 kg (p < 0.003), respectively. Plasma concentrations of albumin, total protein, transferrin, leptin IGF-I, IGFBP-3 and the protein catabolic rate remained unchanged.
Supplementary intravenous intradialytic nutrition in chronic HD patients with malnutrition increased total body weight by effecting equivalent increases in lean body and fat masses.
蛋白质和热量营养不良在慢性血液透析（HD）患者中很常见。最近有人提出，透析期间给予氨基酸进行营养支持可能会改善营养状况并提高免疫能力。本研究的目的是评估透析期间输注氨基酸、脂质和葡萄糖对HD患者身体成分和其他营养状况参数的影响。
7名平均年龄为77±6岁（范围60 - 86岁）、平均体重指数为20.1±2.8（范围16.1 - 24.4）且有营养不良临床体征的患者参与了本研究（平均HD时间为51±36个月）。每周进行12小时的HD，以碳酸氢盐作为缓冲液，使用聚砜毛细管透析器（F - 60）。在为期3个月的干预期间，患者在常规预定透析治疗期间接受透析期间肠外溶液，其中含有氨基酸（12 g s/h）、15%葡萄糖溶液（37.5 g/h）和脂肪乳剂（12.5 g/h）。
（均值±标准误）在干预期间，总热量摄入从1550±63增加至2255±114（千卡/24小时），p < 0.01，体重从49.9±5.9增加至51.9±5.7千克（p < 0.005）。脂肪量和去脂体重（生物电阻抗分析，BIA）分别从13.2±2.6增加至14.2±2.6（p < 0.02）和从36.9±3.2增加至37.9±3.2千克（p < 0.003）。血浆白蛋白、总蛋白、转铁蛋白、瘦素、胰岛素样生长因子 - I、胰岛素样生长因子结合蛋白 - 3浓度以及蛋白质分解代谢率保持不变。
对慢性HD营养不良患者进行补充静脉内透析营养，通过使去脂体重和脂肪量等量增加，使总体重增加。
