Efficacy of preoperative amino acid supplements on postoperative physical function and complications in open heart surgery patients: A study protocol for a randomized controlled trial.
Efficacy of preoperative amino acid supplements on postoperative physical function and complications in open heart surgery patients: A study protocol for a randomized controlled trial.
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DOI：
10.1016/j.jjcc.2019.03.011
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发表时间：
2019-10
影响因子：
2.5
通讯作者：
M. Ogawa;N. Yoshida;S. Satomi-Kobayashi;Y. Tsuboi;K. Komaki;K. Wakida;Y. Gotake;T. Inoue;Hiroshi Tanaka;T. Yamashita;Y. Sakai;K. Izawa;Michiko Takahashi;W. Ogawa;K. Hirata
中科院分区：
文献类型：
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作者：
M. Ogawa;N. Yoshida;S. Satomi-Kobayashi;Y. Tsuboi;K. Komaki;K. Wakida;Y. Gotake;T. Inoue;Hiroshi Tanaka;T. Yamashita;Y. Sakai;K. Izawa;Michiko Takahashi;W. Ogawa;K. Hirata
背景接受心脏手术的老年患者常表现出营养状况不佳、肌肉萎缩和肌肉减少症，据报道这会影响术后功能恢复和并发症的发生。氨基酸对于维持营养状态、合成肌肉蛋白和促进心肌的有益能量平衡至关重要。 β-羟基 β-甲基丁酸 (HMB) 是一种亮氨酸代谢物，已知可增加肌肉蛋白质合成并抑制蛋白质分解代谢；它已被用来更有效地支持因磨损疾病而导致肌肉萎缩的患者。然而，包含 HMB 的氨基酸给药对于接受心脏直视手术的患者的疗效仍不清楚。本研究旨在探讨术前短期积极的氨基酸给药是否有助于支持术后身体功能的恢复并预防并发症。方法这是一项单中心前瞻性随机对照试验（UMIN000030490）。招募年龄≥65岁、心脏手术前住院体检的患者。参与者将被随机分配到实验组或对照组。实验组术前根据肾功能不全程度每天服用1200 mg HMB、7000 mg L-谷氨酰胺和7000 mg L-精氨酸的氨基酸补充剂，每天一次或两次，持续14-28天。对照组不接受任何营养干预。主要结果是术前和术后 6 分钟步行测试距离的变化，作为功能恢复的标志。次要结果，例如并发症的发生率；身体、营养和心理状态；死亡;结论本临床研究将确定术前短期口服补充HMB、L-谷氨酰胺和L-精氨酸对老年心脏手术患者术后身体功能的影响。
BackgroundElderly patients undergoing cardiac surgery often show poor nutritional status, muscle wasting, and sarcopenia, which are reported to affect postoperative functional recovery and incidence of complications. Amino acids are essential in maintaining nutritional status, synthesizing muscle protein, and promoting beneficial energy balance of the heart muscle. β-Hydroxy β-methylbutyric acid (HMB) is a leucine metabolite known to increase muscle protein synthesis and inhibit protein catabolism; it has been used to more effectively support patients with muscle wasting due to wearing diseases. However, the efficacy of amino acid administration comprising HMB in patients undergoing open heart surgery remains unclear. This study aims to examine whether preoperative short-term aggressive amino acid administration helps support postoperative recovery of physical function and prevent complications.MethodsThis is a single-center prospective randomized controlled trial (UMIN000030490). Patients aged ≥65 years who will be hospitalized for medical examination before cardiac surgery will be recruited. The participants will be randomly assigned to the experimental or control group. The experimental group will be administered with an amino acid supplement with HMB 1200 mg,l-glutamine 7000 mg, andl-arginine 7000 mg once or twice per day depending on the degree of renal dysfunction, for 14–28 days preoperatively. The control group will not receive any nutritional intervention. The main outcome will be a change in the 6-min walking test distance pre- and postoperatively as a sign of functional recovery. Secondary outcomes such as the incidence of complications; physical, nutritional, and psychological states; mortality; and length of hospital stay will also be evaluated.ConclusionThis clinical study will determine the effects of preoperative short-term oral amino acid supplementation with HMB,l-glutamine, andl-arginine on postoperative physical function in elderly patients undergoing cardiac surgery.