脂肪乳剂对急性坏死性胰腺炎患者影响的前瞻性研究

Effect of intralipid on patients with acute necrotic pan-creatitls:a prospective clinical study

由ＣＴ或／和手术证实的急性坏死性胰腺炎（ＡＮＰ）患者共１７例，随机分成全糖组（ｎ＝８）和糖脂组（ｎ＝９），实施肠外营养，连续观察２周，选用ＴＧ、ｃｈ、ＬＤＬ、ＨＤＬ、Ａｐｏ－Ａ、Ｂ及ＦＦＡ等指标观察。发现脂肪乳剂在ＡＮＰ患者体内能迅速氧化，无１例发生高脂血症。入院时有６４％伴高糖血症，在发作１０天内血糖较难控制。应用脂肪乳剂后则高糖血症较少发生。脂肪乳剂输注２周内无１例患者出现肝功能损害。从常规指标，以及溶酶体酶、血气分析和并发症发生率等比较，脂肪乳剂长期静脉输注并未使ＡＮＰ患者病情加重。提示ＡＮＰ患者长期输注脂肪乳剂是安全、有效的。

Abstract17 patients with acute necrotic pancreatitis wereproved by CT or operation.These patients wererandomly assigned to fat-glucose-based group(n=9)and glucose-based group(n=8).Their PN regimenconsisted of nonprotein calories(NPC)35-40KJ(146-167KJ)/kg/d and nitrogen 0.19～0. 29g/kg/d. NPCwas supplied bv either dextrose or dextrose and in-tralipid.The PN duration was 2 weeks。 The followingmeasurements were performed:triglyceride,chore-strol,HDL,LDL,Apo-A,Apo-B and free fattv acids。The resuIts showed that there was no hypertriglyc-eridemia developed after fat emulsion was administeredfor two weeks。 It confirmed that fat emulsion could berapidly oxidigzed. In our group,the patients with hy-perglycemia were 64%at the admission time, and hy-perglycemia was difficult to control in early period(10days). But hyperglycemia was easly to control whenpatients received fat emulsion。 There was no harmfuleffect on liver function during 2 weeks of intralipidadministration。The data showed no difference betweenthe two groups on conventional measurements, lysoso-mal enzymes and blood gas analysis。 Intralipid infusiondid not make ANP deterioration。These results indicat-ed long-term intravenous intralipid in patients withANPwas safe and useful。