Effects Of L-Arginine On Nitrogen Balance In Patients With Hepatobiliary Surgery

Background and purpose:Arginine is a conditional essential amino-acid in body. In normal situation, arginine in our body could meet our needs. However, under stress conditions, such as severe burns, major surgery, infection, the demand of arginine increases, and it should be promptly added exogenously. In currently clinical studies, the role of arginine is mainly about improving immune function in patients which can decrease the infection rates, however, the effect on final clinical for example whether it can improve the prognosis of abdominal surgery patients in ICU especially hepatobiliary surgery was rarely reported. We investigated the effect of arginine on nitrogen balance in patients with hepatobiliary surgery, and hope to provide basis for clinical use of arginine.Methods:We enrolled patients after hepatobiliary in ICU, and stratified the patients into two groups randomly after evaluating situation using APS.40patients were in case and control group respectively. Patients were supported with the same nitrogen and calories. Patients in control group were supported by25kcal/kg·d with conventional intravenous nutrition, while the other patients were supported with that basis adding arginine by0.2g/kg·d. Continuously we detected the albumin, pre-albumin, total protein, transferring,blood routine examination; measured the arginine concentration by protentiometric titrtation and plotted arginine concentration-time cure; measured the nitrogen in urine using acid digestion method with selenite, and calculated the nitrogen balance. We also observed the vital signs and the hospitalization time.Results:There is no significant difference in the two groups in generally characteristics. In the fourth day after operation, urine nitrogen of patients in the case group began to reduce, it is statistically significant different with that in control group, it decreased in the seventh day after operation in control group; patients all presented state of malnutrition, after parenteral nutrition therapy for a week, albumin and total protein levels were significantly increased (P<0.05), and they were higher in case group (P<0.05); the blood arginine concentration in control group decreased in the first24hours after operation and recover in the fourth day, but still remained at a low level, while that in the case group remained at a higher level and it was statistically different with that of control group (P<0.05).Conclusion:Parenteral nutrition with arginine is benefit to patients after hepatobiliary in improving the nutritional status and nitrogen equilibrium.