Kuhl D A, Brown R O, Vehe K L, Boucher B A, Luther R W, Kudsk K A
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163.
Surgery. 1990 May;107(5):503-10.
Twenty injured patients in the intensive care unit were randomized to receive parenteral nutrition with either 21% (STD) or 46% (HBC) branched-chain amino acids to compare the response of nitrogen balance (NB), somatomedin-C/insulin-like growth factor I (SMC), circulating fibronectin (FBN), and prealbumin (PA). NB was measured and serum collected for SMC, FBN, and PA on days 1, 4, 7, 14, and 21 of nutritional intervention. The treatment groups did not differ significantly for age, weight, injury severity score, trauma score, Apache II score, acute-phase protein concentrations, or type of injury. Comparison of baseline measurements revealed no significant differences in SMC, FBN, or PA. Both groups received similar doses of nonprotein energy and nitrogen. Baseline urea nitrogen excretion was slightly higher in the STD group (216 +/- 55 vs 268 +/- 54 mg/kg/day p = 0.049). Although NB was significantly improved over baseline during subsequent study days, there were no differences between groups after the day-1 measurement. SMC increased significantly from baseline on day 4 in the STD group, on day 7 in the HBC group, and on days 14 and 21 in both groups. There was no significant difference in SMC concentrations between groups on any day. Each group demonstrated a significant increase in PA from baseline on days 7, 14, and 21; however, no difference was seen when groups were compared. FBN increased significantly from baseline on day 14 in the HBC group and on days 7 and 14 in the STD group. FBN measurements were significantly different between groups on day 14 (STD, 179 +/- 71 vs HBC, 229 +/- 59 micrograms/ml; p less than 0.05). NB, PA, SMC, and FBN improve significantly during parenteral nutrition of traumatized patients. With the measured variables, there appears to be no significant difference between STD or HBC amino acids when used as part of parenteral nutrition in injured patients.
重症监护病房的20名受伤患者被随机分为两组，分别接受含21%（标准组，STD）或46%（高支链氨基酸组，HBC）支链氨基酸的肠外营养，以比较氮平衡（NB）、生长调节素-C/胰岛素样生长因子I（SMC）、循环纤维连接蛋白（FBN）和前白蛋白（PA）的反应。在营养干预的第1、4、7、14和21天测量NB，并采集血清检测SMC、FBN和PA。治疗组在年龄、体重、损伤严重程度评分、创伤评分、急性生理和慢性健康状况评分系统II（Apache II）评分、急性期蛋白浓度或损伤类型方面无显著差异。基线测量结果比较显示，SMC、FBN或PA无显著差异。两组接受的非蛋白能量和氮剂量相似。标准组的基线尿素氮排泄略高（216±55 vs 268±54 mg/kg/天，p = 0.049）。尽管在随后的研究日NB较基线有显著改善，但在第1天测量后两组之间无差异。标准组在第4天、高支链氨基酸组在第7天以及两组在第14天和21天，SMC均较基线显著增加。两组在任何一天的SMC浓度均无显著差异。每组在第7、14和21天PA均较基线显著增加；然而，组间比较时未见差异。高支链氨基酸组在第14天、标准组在第7天和14天FBN较基线显著增加。两组在第14天的FBN测量值有显著差异（标准组，179±71 vs高支链氨基酸组，229±59微克/毫升；p<0.05）。创伤患者肠外营养期间NB、PA、SMC和FBN均显著改善。在所测量的变量方面，标准组或高支链氨基酸组作为受伤患者肠外营养的一部分使用时似乎无显著差异。
