分解代谢患者在未接受肠外营养和接受肠外营养情况下的外周、内脏及机体氮平衡。

Peripheral, visceral and body nitrogen balance of catabolic patients, without and with parenteral nutrition.

作者信息

Radrizzani D, Iapichino G, Cambisano M, Bonetti G, Ronzoni G, Colombo A

机构信息

Reparto di Rianimazione, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore di Milano, Italy.

出版信息

Intensive Care Med. 1988;14(3):212-6. doi: 10.1007/BF00717991.

DOI:10.1007/BF00717991

PMID:3132491

Abstract

The effect of major trauma and sepsis on skeletal muscle, central tissue and whole body nitrogen (N) metabolism was investigated in 5 patients before and during TPN (30 kcal, 0.30 g N kg-1 day-1). Fasting 3-methylhistidine (MEH) urinary excretion was elevated (407.9 +/- 67.6 mumol m-2 day-1), muscle and body N balances (NB) were markedly negative (-28.2 +/- 4.6 g m-2 day-1 and -15.7 +/- 3.1 g m-2 day-1), while central tissue NB was positive (13.0 +/- 2.4 g m-2 day-1). TPN effected a reduction in MEH excretion (261.8 +/- 27.5 mmol m-2 day-1 - p less than 0.05) and decreased the release of almost all amino acids from muscle tissue, some of them acting as catabolic markers. Muscle (-7.2 +/- 1.2 g m-2 day-1 - p less than 0.01) as well as body NB (-4.8 +/- 1.4 g m-2 day-1 - p less than 0.01) improved, whilst central tissue NB worsened, even though still positive (3.1 +/- 1.6 g m-2 day-1 - p less than 0.05). Gathering fasting and TPN data MEH excretion was significantly related to both body (r = 0.89) and muscle (r = 0.73) NB, that were highly related to each other (r = 0.93), being muscle always worse than body NB. In conclusion, the anticatabolic activity of TPN is confirmed, although our setting did not achieve muscle NB, it was consistently improved and seems to be the major determinant of body NB, in contrast central NB and central N utilization (46.4% +/- 5.4 vs 15.8% +/- 8.4 - p less than 0.05) worsened.

摘要

研究了5例患者在全胃肠外营养（TPN，30kcal，0.30g氮·kg⁻¹·天⁻¹）前及期间严重创伤和脓毒症对骨骼肌、中枢组织及全身氮（N）代谢的影响。空腹时尿中3 - 甲基组氨酸（MEH）排泄量升高（407.9±67.6μmol·m⁻²·天⁻¹），肌肉和机体氮平衡（NB）显著为负（-28.2±4.6g·m⁻²·天⁻¹和-15.7±3.1g·m⁻²·天⁻¹），而中枢组织氮平衡为正（13.0±2.4g·m⁻²·天⁻¹）。TPN使MEH排泄减少（261.8±27.5μmol·m⁻²·天⁻¹ - p＜0.05），并减少了几乎所有肌肉组织氨基酸的释放，其中一些氨基酸可作为分解代谢标志物。肌肉氮平衡（-7.2±1.2g·m⁻²·天⁻¹ - p＜0.01）以及机体氮平衡（-4.8±1.4g·m⁻²·天⁻¹ - p＜0.01）得到改善，而中枢组织氮平衡虽仍为正（3.1±1.6g·m⁻²·天⁻¹ - p＜0.05）但恶化。综合空腹及TPN数据，MEH排泄与机体（r = 0.89）和肌肉（r = 0.73）氮平衡显著相关，机体和肌肉氮平衡彼此高度相关（r = 0.93），且肌肉氮平衡始终比机体氮平衡差。总之，TPN的抗分解代谢活性得到证实，尽管本研究未实现肌肉氮平衡，但肌肉氮平衡持续改善且似乎是机体氮平衡的主要决定因素，相比之下，中枢氮平衡和中枢氮利用率（46.4%±5.4对15.8%±8.4 - p＜0.05）恶化。