Okuno M, Nagayama M, Takai T, Rai A, Nakao S, Kamino K, Umeyama K
J Surg Res. 1985 Aug;39(2):93-102. doi: 10.1016/0022-4804(85)90166-0.
Sixty-one patients with liver disorders receiving total parenteral nutrition (TPN) for about 14 postoperative days were divided into three groups based on the parenteral nutritional regimen. The influence of these TPN solutions on the liver function tests and the nutritional assessments, and the availability of the specially formulated amino acid solution were studied. Glucose alone as energy source was infused in Group Ia. The mixture of glucose and fructose was infused in Group Ib. In these patients (Group I), a commercially available amino acid solution was administered simultaneously. A specially formulated amino acid, rich in branched-chain amino acids but poor in aromatic amino acids was infused with the mixture of glucose and fructose in Group II. There was no remarkable elevation of blood glucose and lactate levels in all patients. Blood glucose levels in Group Ib were maintained lower than that in Group Ia. Except for serum alkaline phosphatase, no remarkable abnormality was observed in liver function tests. Body weight changes were less than 5% in each group. Average nitrogen balances were -44.5 mg/kg/day in Group Ia, -5.5 mg/kg/day in Group Ib, -51.5 mg/kg/day in Group II. While the abnormalities in serum amino acid pattern and molar ratio of leucine, isoleucine, and valine to phenylalanine and tyrosine tend to be more enhanced in Group I, these abnormalities returned to near normal in Group II during TPN. By multiple linear regression analyses, 45 kcal/kg/day of energy intake would be required to maintain nitrogen equilibrium and zero body weight change. And when nitrogen intakes were 159 mg/kg/day in Group Ia, 114 mg/kg/day in Group Ib, and 189 mg/kg/day in Group II at 45 kcal/kg/day in energy intake, nitrogen balances were expected to be equivalent. These results suggest that postoperative TPN is good for nutritional support in patients with liver disorders. And also, the combination of glucose and fructose has better effect on nitrogen balance. The postoperative TPN with a specially formulated amino acid solution may be a valuable way of maintaining the nutritional status as well as normal serum amino acid pattern in patients with liver disorders.
61例接受全胃肠外营养（TPN）约14天的肝病患者根据胃肠外营养方案分为三组。研究了这些TPN溶液对肝功能测试和营养评估的影响，以及特制氨基酸溶液的可用性。Ia组仅输注葡萄糖作为能量来源。Ib组输注葡萄糖和果糖的混合物。在这些患者（I组）中，同时给予市售氨基酸溶液。II组将富含支链氨基酸但芳香族氨基酸含量低的特制氨基酸与葡萄糖和果糖的混合物一起输注。所有患者的血糖和乳酸水平均无明显升高。Ib组的血糖水平维持在低于Ia组的水平。除血清碱性磷酸酶外，肝功能测试未观察到明显异常。每组体重变化均小于5%。Ia组平均氮平衡为-44.5mg/kg/天，Ib组为-5.5mg/kg/天，II组为-51.5mg/kg/天。虽然I组血清氨基酸模式以及亮氨酸、异亮氨酸和缬氨酸与苯丙氨酸和酪氨酸的摩尔比异常往往更明显，但在TPN期间II组这些异常恢复到接近正常水平。通过多元线性回归分析，维持氮平衡和体重零变化需要45kcal/kg/天的能量摄入。当能量摄入为45kcal/kg/天，Ia组氮摄入量为159mg/kg/天，Ib组为114mg/kg/天，II组为189mg/kg/天时，预计氮平衡相当。这些结果表明，术后TPN对肝病患者的营养支持有益。而且，葡萄糖和果糖的组合对氮平衡有更好的效果。术后使用特制氨基酸溶液的TPN可能是维持肝病患者营养状况以及正常血清氨基酸模式的一种有价值的方法。
