EFFICIENCY OF ENTERAL NITROGEN SUPPORT IN SURGICAL PATIENTS - SMALL PEPTIDES NU-NON-DEGRADED PROTEINS
EFFICIENCY OF ENTERAL NITROGEN SUPPORT IN SURGICAL PATIENTS - SMALL PEPTIDES NU-NON-DEGRADED PROTEINS
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DOI：
10.1136/gut.31.11.1277
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发表时间：
1990-11-01
期刊：
影响因子：
24.5
通讯作者：
GIBOUDEAU, J
中科院分区：
文献类型：
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作者：
ZIEGLER, F;OLLIVIER, JM;GIBOUDEAU, J
在一项前瞻性研究中，12名重症监护患者在腹部手术后接受了三个交替的为期六天的两种肠内饮食，其中提供相同的氮（0.3 g N/kg/天）和能量（60 kcal/kg/天）。蛋白质水解物（PH）的饮食含有酶水解酪蛋白和乳清（60%的小肽），而非降解蛋白质（NDP）的饮食含有类似的氨基酸组成的氮源，但在非降解蛋白质的形式。患者随机接受PH-NDP-PH或NDP-PH-NDP。在第1、6、12和18天，停止营养后3小时（t0）和重新开始营养后1小时（t1），评估血浆、尿液或造口流出物中反映蛋白质代谢的参数。t1和t0值的比较表明，13种氨基酸（包括8种必需氨基酸）与蛋白质水解物饮食显着增加，但只有两个增加与非降解蛋白质饮食。同样，蛋白质水解物，胰岛素血症在t1显着高于在t0和相关的血浆亮氨酸，苯丙氨酸，丙氨酸和赖氨酸浓度。此外，血浆白蛋白，转铁蛋白，和视黄醇结合蛋白浓度显着改善与蛋白质水解物，以及血浆苯丙氨酸/酪氨酸比值和尿3-甲基组氨酸排泄显着降低。我们的结论是，在腹部手术后的重症监护患者中，含有小肽的肠内支持比含有全蛋白的等效饮食更有效地恢复血浆氨基酸和蛋白质水平。
In a prospective study, 12 intensive care patients, after abdominal surgery, received three alternate six-day courses of two enteral diets with identical nitrogen (0.3 g N/kg per day) and energy (60 kcal/kg per day) supply. The protein hydrolysate (PH) diet contained enzyme-hydrolysed casein and lactoserum (60% small peptides), while the non-degraded protein (NDP) diet contained a nitrogen source of similar amino acid composition, but in the form of non-degraded proteins. The patients were randomised to receive either PH-NDP-PH or NDP-PH-NDP. Parameters reflecting protein metabolism were assessed in the plasma, urine, or stomal effluent on days 1, 6, 12, and 18, three hours after stopping the nutrition (t0), and one hour after restarting it (t1). Comparisons of t1 and t0 values showed that 13 amino acids (including the eight essential amino acids) increased significantly with the protein hydrolysate diet, but only two increased with the non-degraded protein diet. Similarly, with protein hydrolysate, insulinaemia at t1 was significantly higher than at t0 and correlated with plasma leucine, phenylalanine, alanine, and lysine concentrations. In addition, significant improvements in plasma albumin, transferrin, and retinol binding protein concentrations were seen with protein hydrolysate, together with a significant decrease in the plasma phenylalanine/tyrosine ratio and urinary 3-methylhistidine excretion. We conclude that in patients in intensive care after abdominal surgery enteral support containing small peptides is more effective than an equivalent diet containing whole proteins in restoring plasma amino acid and protein levels.