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題名 | Serum Amino Acid Pattern in Total Parenteral Nutrition with Essential Amino Acids as the Sole Nitrogen Source=全靜脈營養以必需胺基酸為唯一氮來源之血液胺基酸相的改變 |
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作者 | 李政昌; 賴鴻緒; 陳維昭; 王新臺; 張智仁; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 28:5 民84.09-10 |
頁次 | 頁341-348 |
分類號 | 416.351 |
關鍵詞 | 全靜脈營養; 胺基酸; 氮; 血液; Total parenteral nutrition; Essential amino acid; Urea cycle; Mixed amino acids; Hyperammonemia; |
語文 | 英文(English) |
中文摘要 | 尿毒病人,以必需胺基酸為全靜脈營養之唯一氮來源時,偶有報告會發生高氨血症腦病變的併發症。此種併發症,我們在腎臟功能正常的病人,亦曾碰過。在我們以前的實驗中,發現在以必需胺基酸為唯一氮來源之全靜脈營養的每隻小白鼠,均發現有高氨血症的現象,其血漿中之平均氯濃度合,比起隨意進食之對照組及同樣注射日數,但以混胺基酸為氮來源之全靜脈營養組,呈現有意義之昇高,在這次實驗中,我們更進一步來檢查這些不同組別之小白鼠,其血中之胺基酸相,以期能進一步探討高氨血症之機轉。以必需胺基酸為氮來源之全靜脈營養之老鼠,其血液中之必需胺基酸與非必胺基酸之濃度,除了氨基乙酸(glycine)及尿素環中之胺基酸如西瓜胺基酸(citrulline)和鳥胺基酸(ornithine)外,與隨意進食組及以混合胺基酸為氮來源之全靜營養組,並無明顯差別。以必需胺基酸為氮來源之全靜脈營養組,其血漿中之阿金胺基酸濃度並未比以混合胺基酸為氮來源之那組或對照組低;但其血漿中之西瓜胺基酸及鳥胺基酸,則比以混合胺基酸為氮來源那組及對照組低。完全以必需胺基酸為全靜脈營養之氮來源,確會造成高氨血症。「所注射的必需胺基酸成份中,缺乏阿金胺基酸」,無法完全解釋高氨血症。因胺基酸失衡而導致尿素環中之阿金基一丁二酸鹽製造(arginosuccinate synthetase)之抑制,而造成西瓜胺基酸及鳥胺基酸之缺乏,可能在高氨血症中,扮演重要的角色,但其機轉,則複雜多了。當病人需要全靜脈營養時,應儘量避免以必需胺基酸為唯一之氮來源;若不得己需用必需胺基酸,則需經常檢查血中之氯濃度。若血中氯濃度昇高,或有高氨血症之毒性出現時,需趕快停掉必需胺基酸。 |
英文摘要 | Hyperammonemic encephalopathy was found in every rat given total parenteral nutrition (TPN) with essential amino acids (EAA) as the only source of nitrogen in a previous experiment here. The amino acid pattern in the serum was checked to determine its mechanism. Forty male Long-Evan rats were divided into five equal groups receiving feed ad libitum or with different formulae of TPN. The serum ammonia levels of the rats given TPN with EAA as the only source of nitrogen were significantly higher than that of the control group given food ad libitum and groups given TPN for the same number of days but with mixed amino acids (MAA) as the source of nitrogen. The mean concentration of essential and nonessential amino acids of the groups given TPN with EAA was not distinct from that of the corresponding groups given TPN with MAA, except for the mean concentrations of some urea-cycle amino acids such as citrulline and ornithine, and glycine in the serum. The mean concentration of arginine in serum of the TPN with EAA groups was not lower than that of the corresponding groups given TPN with MAA and the control group. The mean serum level of other amino acids in the urea cycle such as ornithine or citrulline, was lower in the groups given TPN with EAA than that of groups given TPN with MAA and the control group, especially the three-day group. It was concluded that TPN using EAA exclusively as the source of nitrogen resulted in hyperammonemia. The deficiency of arginine in the formula failed to account for the hyperammonemia observed. Deficiencies of citrulline and ornithine resulting from inhibition of arginosuccinate synthetase may play a part, but the mechanism may be much more complicated. EAAs are to be avoided as the only source of nitrogen when TPN is indicated and if their use is necessary, the serum ammonia level should be tested frequently. If the level remains elevated or if toxicity develops, consideration should be given to an alternative fluid. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。