CAJ | 학술논문

目的探讨腹腔感染合并急性肾功能衰竭患者连续静脉-静脉血液滤过(CVVH)治疗前后血浆氨基酸水平变化和氨基酸丢失量.方法回顾性分析2008年9月至2009年9月南京军区南京总医院收治的10例腹腔感染合并急性肾功能衰竭患者的临床资料.采用AV600S聚砜膜行24 h CVVH治疗,分别采集CVVH治疗前、治疗12 h和24 h血浆,连续收集24 h滤液.高压液相色谱测定血浆和滤液氨基酸浓度,并计算滤液氨基酸丢失量.采用配对t检验或Wilcoxon秩和检验,一元线性回归分析变量之间的关系.结果 10例患者中死亡6例,其中3例死于脓毒性休克,3例死于MODS.CVVH治疗24 h后血浆各种氨基酸水平显著下降,其中组氨酸、异亮氨酸、半胱氨酸和谷氨酰胺分别由(22.1±10.3)、(20.0±7.6)、(10.3±4.7)、(122.3±72.2)μmoL/L下降至(5.6±3.4)、(6.4±2.5)、(2.9±2.4)、(42.5±33.6)μmol/L.血浆总氨基酸水平呈下降趋势,CVVH治疗12 h和24 h分别下降52%和59%.滤液氨基酸24 h平均丢失量为(9631±1089)mg/d,其中非必需氨基酸和必需氨基酸丢失量分别为(5072±618)mg/d和(3747±654)mg/d,两者比较,差异有统计学意义(t=4.52,P＜0.05).CVVH治疗12 h后滤液氨基酸丢失量和血浆氨基酸水平之间呈正相关(r=0.68,P＜0.05).结论腹腔感染患者接受CVVH治疗时,氨基酸可以经滤液丢失,因此,为CVVH患者制定营养方案时,滤液额外丢失的氨基酸需要考虑在内,尤其要适当增加非必需氨基酸的含量.
목적 탐토복강감염합병급성신공능쇠갈환자련속정맥-정맥혈액려과(CVVH)치료전후혈장안기산수평변화화안기산주실량.방법 회고성분석2008년9월지2009년9월남경군구남경총의원수치적10례복강감염합병급성신공능쇠갈환자적림상자료.채용AV600S취풍막행24 h CVVH치료,분별채집CVVH치료전、치료12 h화24 h혈장,련속수집24 h려액.고압액상색보측정혈장화려액안기산농도,병계산려액안기산주실량.채용배대t검험혹Wilcoxon질화검험,일원선성회귀분석변량지간적관계.결과 10례환자중사망6례,기중3례사우농독성휴극,3례사우MODS.CVVH치료24 h후혈장각충안기산수평현저하강,기중조안산、이량안산、반광안산화곡안선알분별유(22.1±10.3)、(20.0±7.6)、(10.3±4.7)、(122.3±72.2)μmoL/L하강지(5.6±3.4)、(6.4±2.5)、(2.9±2.4)、(42.5±33.6)μmol/L.혈장총안기산수평정하강추세,CVVH치료12 h화24 h분별하강52%화59%.려액안기산24 h평균주실량위(9631±1089)mg/d,기중비필수안기산화필수안기산주실량분별위(5072±618)mg/d화(3747±654)mg/d,량자비교,차이유통계학의의(t=4.52,P＜0.05).CVVH치료12 h후려액안기산주실량화혈장안기산수평지간정정상관(r=0.68,P＜0.05).결론 복강감염환자접수CVVH치료시,안기산가이경려액주실,인차,위CVVH환자제정영양방안시,려액액외주실적안기산수요고필재내,우기요괄당증가비필수안기산적함량.
Objective To evaluate the plasma amino acid level alteration and determine amino acid loss in patients with abdominal inflammation and acute renal failure during continuous veno-venous hemofiltration (CVVH). Methods Ten patients with abdominal infection and acute renal failure were admitted to the Nanjing General Hospital of Nanjing Military Command of PLA from September 2008 to September 2009. CVVH was performed with AV600S polysulfone hemofilter for 24 hours. Samples of plasma amino acid were obtained before,at 12 and 24 hours after the beginning of CVVH. High pressure liquid chromatography was used to detect amino acid concentrations in plasma and replacement fluid. All data were analyzed using t test or Wilcoxon rank sum test. Results Of the ten patients, three died of septic shock and three died of multi-organ dysfunction syndrome.The level of plasma amino acids decreased significantly after CVVH, and the levels of histidine, isoleucine, cysteine and glutamine decreased from (22.1 ±10.3), (20.0 ±7.6), (10.3±4.7), (122.3 ±72.2)μmol/L to (5.6 ±3.4), ( 6.4 ± 2.5 ), ( 2.9 ± 2.4 ), (42.5 ± 33.6) μ mol/L. The total plasma amino acid levels significantly reduced by 52% at 12 hours after the beginning of CVVH and by 59% at 24 hours after the beginning of CVVH.The mean amino acid loss was (9631± 1089)mg/d. The mean losses of essential and non-essential amino acids were ( 5072 ± 618 ) mg/d and ( 3747 ± 654 ) mg/d, respectively, with a significant difference ( t = 4. 52,P ＜0.05 ). There was a positive correlation between individual amino acid loss and the plasma concentrations of respective amino acids at 12 hours after the beginning of CVVH ( r = 0. 68, P ＜ 0.05 ). Conclusions Plasma amino acid would be cleared through hemofilter during CVVH in patients with abdominal inflammation and acuterenal failure. As a result, it is necessary to take account of the ultrafiltrate amino acid loss when setting nutritional schedule, especially increasing the non-essential amino acid content of total parenteral nutrition.