透過您的圖書館登入
IP:52.90.40.84
  • 期刊
  • OpenAccess

比較胜肽配方與胺基酸元素配方:對消化道手術後患者耐受性與營養指標之影響

Tolerance and Nutritional Outcome Using a Peptide-Based Formula and an Amino Acid-Based Elemental Formula for Post-gastrointestinal Surgical Patients

摘要


當病人禁食或接受全靜脈營養超過3-5天後,經常會導致腸道黏膜上的微絨毛長度減少及腸黏膜萎縮等現象發生,而病人的消化和吸收功能也隨之降低,因此手術後長期禁食或由全靜脈營養轉換至腸道營養的病人,建議以元素配方或預解配方為初期腸道配方。本研究是將40位胃腸手術後的病人隨機分配為兩組,使用兩種不同成份的腸道配方。一組是預解配方組-使用Nu-pep,其氮來源為100%胜?,其成份為蛋白質20%,碳水化合物65%,油脂15%(含一半的中鏈脂肪酸),滲透壓395mOsm/kgH2O。另一組為元素配方組-使用Vivonex-plus,其氮來源為100%游離胺基酸,其成份為蛋白質18%,碳水化合物76%,油脂6%,滲透壓650 mOsm/kgH2O。在腸道營養使用初期,Nu-pep採全濃度配方,而Vivonex-plus為半濃度配方,初期灌食速率二者均為25mL/hr,然後逐漸增加,大約需4-5天,可達病人每日的營養需要量。經分析二組之結果後,發現元素配方組發生腸道不耐症及血糖不耐症的比率較高,其中原本患有糖尿病的病人此現象更為明顯。而兩組在其他營養指標上,例如血液生化值中之白蛋白、前白蛋白及運鐵蛋白等數值相似,且均維持在正常範圍。由上述結果顯示,消化道手術後病患在全靜脈營養轉換至腸道營養初期,使用胜?為主的預解配方比胺基酸為主的元素配方有較好的腸道耐受度,其可能原因是源自碳水化合物含量的差異(65%:76%)及滲透壓的不同(395:650mOsm/kgH2O),因此,對於重症病人而言,血糖控制與胃腸耐受度是決定營養支持是否合適的重要指標。

並列摘要


When experiencing NPO (nothing by mouth) for more than 3-5 days or receiving only total parenteral nutrition (TPN) as nutritional support, the height of a patient's intestinal mucosal villi may decrease, and gut atrophy may occur. A patient's digestion and absorption may also decrease. Elemental or predigested formula has been suggested for use in the transition from TPN to total enteral nutrition (TEN) or after a long starvation period in post-surgical patients. Forty post-gastrointestinal (GI) surgical patients were randomly divided into two groups and subjected to a controlled clinical trial. Each of the two different elemental formulas was assigned to one of the groups. One formula consisted of 100% peptide-based Nu-Pep (20% protein, 65% carbohydrates and 15% fat (including 50% medium chain triglycerides); 395 mOsm/kg H2O), and the other was 100% amino acid-based Vivonex Plus (18% protein, 76% carbohydrates, and 6% fat; 650 mOsm/kg H2O). Full-strength Nu-Pep and half-strength Vivonex Plus were administered with a starting rate of 25 mL/h, then gradually increased to meet patients caloric requirements in 4 ± 2 and 5±2 days. Respectively. With similar intake of full-strength formula, the occurrence of GI intolerance was significantly higher in the Vivonex Plus group. The incidence of blood glucose intolerance (blood sugar> 200 mg/dL) and required insulin injections were significantly higher in the Vivonex Plus group, especially for those patients with a diabetes mellitus history. Between the two groups, serum albumin, prealbumin, transferring, and all postoperative nutritional parameters were similar and remained within acceptable levels. The present findings show that the 100% enzymatic hydrolytic whey-peptide-based formula was better tolerated than the 100 % free amino acid-based formula among patients after GI surgery. A relatively lower carbohydrate level (65% vs 76%) and milder osmolarity (395 vs 650 mOsm/kg H2O) may be the major important indicators of lower blood sugar and better GI tolerance for critically ill patients.

被引用紀錄


王曼珊(2009)。經腸胃道術後老人接受個別化營養策略之成效探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2009.01409

延伸閱讀