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Title:	Perbandingan status keseimbangan nitrogen di kalangan pesakit pembedahan yang menerima nutrisi parenteral
Authors:	Mohd. Haz Hairul Amran Rajadran (P46721)
Supervisor:	Ahmad Fuad Shamsuddin, Prof. Madya Dr.
Keywords:	Nutrisi parenteral Parenteral Nutrition
Issue Date:	8-Mar-2012
Description:	Nutrisi parenteral (PP) merupakan kaedah penyampaian nutrien bilamana pesakit gagal menerima nutrien secara oral mahupun enteral. PP pra pembedahan dilapor dapat meningkatkan status nutrisi pesakit pasca pembedahan. Kesan anabolik protein adalah salah satu tanda positif hasil daripada PP dan dapat diukur melalui keseimbangan nitrogen. Kajian prospektif yang dilaksana bertujuan menilai kesan PP pra pembedahan terhadap keseimbangan nitrogen. Pesakit daripada empat buah hospital dipilih secara mudah bagi kajian ini. Seramai 34 orang pesakit pembedahan dewasa diberi PP pasca pembedahan. Daripada pesakit-pesakit ini, seramai 14 orang menerima PP secara pra dan pasca pembedahan (Kumpulan A), sementara 20 orang lagi hanya menerima PP pasca pembedahan (Kumpulan B). Pengumpulan urin 24 jam dilakukan bagi mengukur kandungan nitrogen diekskresi. Keseimbangan nitrogen diukur pada hari kedua dan ketujuh penggunaan PP pasca pembedahan. Nitrogen dihitung berdasarkan penentuan kandungan ammonia di dalam urin dikumpul. Ammonia ditentukan secara spektrofotometrik berdasarkan kaedah Berthelot. Proses penyelidikan ini termasuk kajian rintis, penyediaan reagen Berthelot, penentuan panjang gelombang UV, penentuan keluk penyerapan dan keluk piawai bagi ammonia. Kandungan nitrogen di dalam air juga turut ditentukan. Ujian pembekuan- pencairan dijalankan bagi menentukan ketahanan sampel urin. Kandungan nitrogen dalam regimen PP yang digunakan adalah antara 0.13 ± 0.03 g/kg/hari hingga 0.21 ± 0.08 g/kg/hari. Tempoh pesakit menerima PP pra pembedahan adalah selama 10.4 ± 6.5 hari. Tempoh ini berbeza sebagaimana dicadang oleh ESPEN iaitu 14 hari. Analisis terhadap urin melibatkan proses pencairan sampel kepada 1:20, reaksi enzim urease bagi menghidrolisis urea kepada ammonia, reaksi reagen Berthelot bagi pewarnaan ammonia kepada warna biru, inkubasi sampel pada suhu 370C selama 15 minit hingga 30 minit dan pencerapan spektrofotometer pada panjang gelombang UV 637.8 nm. Hasil kajian ini menunjukkan kandungan nitrogen diekskresi hanya berbeza secara signifikan pada hari ketujuh penggunaan PP (Kumpulan A, median = 4.54 g; Kumpulan B, median = 4.44 g; p=0.037) (perbezaan min = 1.24; 95% CI, 0.02-2.45). Keseimbangan nitrogen yang dicapai pula tidak berbeza secara signifikan pada hari kedua (Kumpulan A, median = 4.32 g; Kumpulan B, median = 2.85 g; p=0.195) (perbezaan min = 0.69; 95% CI, -1.32-2.69) dan ketujuh penggunaan PP (Kumpulan A, median = 3.98 g; Kumpulan B, median = 5.93 g; p=0.459) (perbezaan min = -3.02; 95% CI, -7.30-1.26). Perbezaan keseimbangan nitrogen pada hari kedua dan ketujuh bagi kedua-dua kumpulan dikaji juga tidak berbeza secara signifikan (U = 112.00, z = -0.980, p=0.327). Protein dibekal berkorelasi secara terus kepada keseimbangan nitrogen pada hari kedua (r (34) = 0.956, p<0.001) dan ketujuh (r (34) = 0.842, p<0.001). Kajian ini mendapati pembekalan PP pra pembedahan berjaya merangsang keseimbangan nitrogen yang positif bagi pesakit pasca pembedahan. Namun, ianya menunjukkan tiada perbezaan yang signifikan berbanding pesakit tidak menerima PP pra pembedahan. Keputusan ini mungkin disebabkan oleh ketidakpatuhan kepada garispanduan PP.,Parenteral nutrition (PN) is a method of nutrient delivery whenever patients fail to receive nutrients through the oral or enteral route. Pre surgical PN has been reported to improve patients' pre-surgery nutritional status. Anabolic effect is a positive sign of PN and can be determined by measuring the nitrogen balance. The prospective study aimed to evaluate the effect of PN on nitrogen balance. Patients from four hospitals were conveniently selected for this study. Thirty four adult patients were included in this study. Among the patients, 14 received PN pre and post surgery (Group A), while another 20 only received PN post surgery (Group B). Twenty four hours urine was collected for nitrogen excretion measurements. Nitrogen balance was determined on day two and seven of PN administration post surgery. Nitrogen was calculated through the determination of ammonia content of the urine collected. Ammonia was determined by spectrophotometry following the method of Berthelot. This process includes pilot project, Berthelot's reagent preparation, determination of ammonia wavelength, absorption curve and standard curve determination for ammonia. The nitrogen content in water was also determined. Freeze-thaw test was conducted to determine robustness of samples. Patients received 0.13 ± 0.03 g/kg/day to 0.21 ± 0.08 g/kg/day nitrogen through PN. The duration of patients receiving PN was 10.4 ± 6.5 days. It is different from the regimen suggested by ESPEN that is 14 days. Urine analysis involved dilution of the sample to 1:20, urease enzyme's reaction for hydrolysis of urea to ammonia, Berthelot's reaction to give blue colour for the ammonia, incubation of the sample at 370C for 15 to 30 minutes and spectrophotometer absorption at 637.8 nm. This study shows that nitrogen excretion only differ significantly on day seven PN used (Group A, median = 4.54 g; Group B, median = 4.44 g; p=0.037) (mean difference = 1.24; 95% CI, 0.02-2.45). Nitrogen balance achieved showed no significant difference on day two (Group A, median = 4.32 g; Group B, median = 2.85 g; p=0.195) (mean difference = 0.69; 95% CI, -1.32-2.69) and day seven (Group A, median = 3.98 g; Group B, median = 5.93 g; p=0.459) (mean difference = -3.02; 95% CI, -7.30-1.26) after PN administration. Nitrogen balance difference for day two and day seven for both study group also showed no significant differences (U = 112.00, z = -0.980, p = 0.327). Supplied protein correlate in linear manner to nitrogen balance on day two (r (34) = 0.956, p<0.001) and day seven (r (34) = 0.842, p<0.001) post PN administration. Current study shows that, pre surgery PN was able to stimulate positive nitrogen balance among post surgery patient. Nevertheless, it showed no significant difference compared to non pre-operational PN patients. The result could be due to non-compliance to the PN guidelines.,Master/Sarjana
Pages:	154
Call Number:	WB410.M698p 2012 9 tesis
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Pharmacy / Fakulti Farmasi

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