Jaing Z M, Zhang F S, Zhu Y, He G Z, Fei L M, Tseng H C, Sugarbaker S, Wilmore D W
Department of Surgery, Peking Union Medical University, Peking Union Medical College Hospital, Beijing.
Surg Gynecol Obstet. 1988 Feb;166(2):115-20.
A variety of investigators have attempted to improve nitrogen balance during the postoperative period by modifying the composition of the infused nutrient solutions. This study compared the metabolic effects of administering standard amino acid solutions with a solution enriched with branched chain amino acids (BCAA). A prospective, randomized clinical study was performed in patients who had undergone subtotal gastrectomy or hemicolectomy, and subsequently cared for in the metabolic care unit. The patients were selected from specific entry criteria so that two groups of individuals were comparable. All patients underwent operation without complications. The plasma concentrations of valine and leucine were significantly increased (p less than 0.05 and p less than 0.01, respectively) two days after administration of solutions enriched with BCAA and throughout the entire postoperative period. The plasma glutamine concentrations tended to decrease in both groups; no concentration difference occurred between groups. Nitrogen balance tended to be more positive in the group receiving BCAA but there was no significant difference between groups after operation. Urinary excretion of 3-methylhistidine tended to increase postoperatively in both groups, but no difference occurred between groups. However, the urine excretion of isoleucine increased significantly in the patients receiving infusions enriched with BCAA. Both standard balanced amino acid and amino solutions enriched with BCAA were well tolerated in all patients.
许多研究人员试图通过改变输注营养液的成分来改善术后氮平衡。本研究比较了给予标准氨基酸溶液和富含支链氨基酸（BCAA）溶液的代谢效应。对接受胃大部切除术或半结肠切除术并随后在代谢护理单元接受护理的患者进行了一项前瞻性随机临床研究。根据特定入选标准选择患者，以使两组个体具有可比性。所有患者手术均无并发症。给予富含BCAA的溶液后两天及整个术后期间，血浆缬氨酸和亮氨酸浓度显著升高（分别为p<0.05和p<0.01）。两组血浆谷氨酰胺浓度均有下降趋势；两组间无浓度差异。接受BCAA组的氮平衡倾向于更正向，但术后两组间无显著差异。两组术后3-甲基组氨酸尿排泄量均有增加趋势，但两组间无差异。然而，接受富含BCAA输注的患者异亮氨酸尿排泄量显著增加。所有患者对标准平衡氨基酸溶液和富含BCAA的氨基酸溶液耐受性均良好。
