Vesali R F, Klaude M, Rooyackers O E, TJäder I, Barle H, Wernerman J
Department of Anesthesiology & Intensive Care and Clinical Research Center at Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
Clin Nutr. 2002 Dec;21(6):505-14. doi: 10.1054/clnu.2002.0583.
BACKGROUND & AIMS: Progressive muscle wasting is a characteristic feature of patients treated at the intensive care unit (ICU). As a consequence, endogenous glutamine production by skeletal muscle may be compromised. We investigated the time pattern of the glutamine and glutamate net balance across the leg in long-stay ICU patients.
Critically ill patients with multiple organ failure that were expected to stay in the ICU for more than 3 days were included in a longitudinal study. Possible changes in amino acid net balance over the leg muscle were investigated overtime. The patients (n=20) were studied descriptively every third or fourth day, on a total of 2-7 occasions.
The glutamine net release from leg muscles did not change significantly during the initial 2 weeks of ICU stay and was not related to the plasma concentration of glutamine. The net uptake of glutamate across the leg muscles was unaltered during this time period, but it was found to correlate statistically with both the arterial glutamate concentration and the glutamine net release. A continuous net release of phenylalanine indicated a progressive net loss of muscle protein in these patients.
The net release of glutamine from skeletal muscle does not decrease in stabilized critically ill patients with multiple organ failure over the initial 2 weeks of ICU stay, despite progressive muscle wasting.
进行性肌肉萎缩是重症监护病房（ICU）患者的一个特征性表现。因此，骨骼肌内源性谷氨酰胺的生成可能会受到影响。我们研究了长期入住ICU患者腿部谷氨酰胺和谷氨酸净平衡的时间模式。
将预计在ICU停留超过3天的多器官功能衰竭重症患者纳入一项纵向研究。对腿部肌肉氨基酸净平衡随时间的可能变化进行了研究。对患者（n = 20）每隔第三天或第四天进行描述性研究，共进行2至7次。
在入住ICU的最初2周内，腿部肌肉谷氨酰胺的净释放量没有显著变化，且与血浆谷氨酰胺浓度无关。在此期间，腿部肌肉对谷氨酸的净摄取量未改变，但发现其与动脉谷氨酸浓度和谷氨酰胺净释放均存在统计学相关性。苯丙氨酸的持续净释放表明这些患者肌肉蛋白出现进行性净丢失。
在入住ICU的最初2周内，尽管存在进行性肌肉萎缩，但多器官功能衰竭病情稳定的重症患者骨骼肌谷氨酰胺的净释放并未减少。
