個 案 報 告 特 殊 混 合 胺 基 酸 用 於 輔 助 化 學 性 燒 燙 傷 之 傷 口 癒 合 1 1 1 1 1,2 12 3 摘 要 arginine glutamine Beta-hydroxy-beta-methylbutyrate HMB 32 2-3 3% 23 6 cm 2011 2 24 2 2 25 2839 kcal 101% 146 g 94.2% 15 arginine glutamine HMB 23 6 cm 14 7 cm 63.5 kg 64 kg arginine glutamine HMB Beta-hydroxy-beta-methyl butyrate HMB 前 言 1 arginine NO synthase 6 03-3621000 3130 tmu0217@adml.cgmh.org.tw TJD 2011;3(1):53-58 Taiwan Journal of Dietetics
劉 金 華 NO NO T arginine arginase ornithine ornithine polyamine 2 Polyamine 3 arginine arginine 4 glutamine 5 glutamine glutamine 6 Beta-hydroxy-beta-methylbutyrate HMB leucine 7 8 arginine glutamine HMB 個 案 簡 介 32 167.5 cm 63.5 kg BMI 22.6 kg/m 2 2011 2 24 200 2-3 3% 23 6 cm 2 6 2 cm 2 sulfasil cream staphylococcus 2011 3 1 tangential excision sulfasil cream 2011 3 8 tangential excision mepilex-ag 2011 3 21 營 養 照 護 2011 2 25 ( ) GFR estimated (ml/m/1.7m 2 ) >60 MCV (fl) 92.8 BUN (mg/dl) 9 MCH (pg/cell) 32.4 Creatinine (mg/dl) 0.94 MCHC (ghb/dl) 34.9 AST/GOT (U/L) 29 RDW (1000/uL) 11.3 Na (meq/l) 140.7 Platelets (%) 277 K (meq/l) 3.97 Segment (%) 53.6 WBC (1000/uL) 5.8 Lymphocyte (%) 43.1 RBC (million) 4.69 Monocyte (%) 2.7 Hemoglobin (g/dl) 15.2 Eosinophil (%) 0.3 Hematocrit (%) 43.5 Basophil (%) 0.3. 54.
特 殊 混 合 胺 基 酸 用 於 化 學 性 燒 燙 傷 之 傷 口 癒 合 kcal/day 3500 3000 2500 2000 1500 1000 500 0 daily calorie intake daily protein intake body weight (kg) 63.5 64 64 0225 0227 0301 0305 0307 0309 0311 0313 0315 0317 0319 Date 300 250 200 150 100 50 g/day 2011.3.1 2011.3.8 2011.3.5-2011.3.19 Long s modified the Harris-Benedict equation [ 66+ ( 13.7 BW+ ( 5 BH )-( 6.8 age ) 1.3 ( ) 1.4 ( )] 2800 kcal/day 155 g/day ( 2.5 g/kg BW ) 2839 kcal/day ( 1350-3250 kcal/ day) ( ) 146 g/day ( 75-188 g/day ) 100 3 5 3 19 2 pc/day ( HMB 1.2 g/pc glutamine 7 g/ pc arginine 7 g/pc 15 ) 2011 2 24 23 6 cm 2 2011 3 21 14 7 cm 2 63.5 kg 64 kg 討 論 catecholamines glucocorticoids glucagon 9 2008 38-61 kcal/kg/day 3050-4880 kcal / day 9 basal metabolic rate, BMR 1.5-2 10 Long s modified the Harris- Benedict equation 2800 kcal/day 44 kcal/kg/ day BMR 1.8 2839 kcal/day 1350-3250 kcal/day 101%. 55.
劉 金 華 2011.2.24 ( 23 6 cm 2 ) 2011.3.4 ( 21 11 cm 2 ) 2011.3.9 ( 18 7 cm 2 ) 2011.3.15 ( 18 7 cm 2 ) 2011.3.21 ( 14 7 cm 2 ) 2011 2 24-2011 3 21. 56. RNA DNA 11-12 155 g/day 2.5 g/kg BW 146 g/day 75-188 g/day 94.2% 2-3 g/kg BW/ day 15-25% 9 Masters 20% C3 IgA 9 6 2.2 g/kg/day 40.8 kcal/ kg/day 1.4 g/kg/ day 40.8 kcal/kg/day 13 30-35 kcal/kg/day protein hydrolysate 70 g/day 1.7-2 g/kg/day 1.3-1.5 g/kg/day 10 63.5 kg 64 kg 3 g/kg BW/day 25% 9,13,14 60-65% 10 glucose 14 10 insulin 9-3 omega-3 fatty acid 12,15
特 殊 混 合 胺 基 酸 用 於 化 學 性 燒 燙 傷 之 傷 口 癒 合 9 16 immunonutrients glutamine arginine -3 omega-3 fatty acid nucleotide glycine 9 Peng 2006 14 glutamine granules 0.5 g/kg/day glutamine 17 arginine 2002 arginine 18 Kirk 1993 30 >65 17 g/day arginine 14 15 HMB HMB 7,19 Williams 2002 >70 arginine 14 g/ day glutamine 14 g/day HMB 3 g/day arginine ornithine 19 結 論 HMB 4.8 g/day glutamine 14 g/day arginine 14 g/day 15 23 6 cm 2 14 7 cm 2 63.5 kg 64 kg 參 考 文 獻 1. Katona P, Katona-Apte J. The Interaction between Nutrition and Infection. Clin Infect Dis 2008;46:1582-1588. 2. Field CJ, Johnson I, Pratt VC. Glutamine and arginine: immunonutrients for improved health. Med sci sports exerc 2000;32 (7 Suppl):S377-S388. 3. Knowles RG, Palacios M, Palmer RMJ, Moncada S. Formation of nitric oxide from L-arginine in the central nervous system: A transduction mechanism for stimulation of the soluble guanylate cyclase. Proc Natl Acad Sci U. S. A 1989;86:5159-5162. 4. Welters CFM, Dejong CHC, Deutz NEP, Heineman E. Effects of parenteral arginine supplementation on the intestinal adaptive response after massive small bowel resection in the rat. J surg res 1999;85:259-266,. 5. Lacey JM, Crouch JB, Benfell K, Ringer SA, Wilmore CK, Maguire D, Wilmore DW. The effects of glutaminesupplemented parenteral nutrition in premature infants. J parenter enteral nutr 1996;20:74-80. 6. Kapadia CR, Muhlbacher F, Smith RJ, Wilmore DW. Alternations in glutamine. 57.
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