添加1,6二-磷酸果糖的肠外营养在老年腹部手术病人中的应用

Application of parenteral nutrition with fructose-1,6-diphosphate in elder abdominal operative patients

目的：探讨添加1，6-二磷酸果糖（FDP）的肠外营养在老年腹部手术病人中的应用价值。方法：将32例病人随机分成研究组和对照组，每组各16例。所有病人术后第1-6d接受等热量83．6kJ／（kg·d）和等氮0．2g／（kg·d）的肠外营养。研究组不用甘油磷酸钠，手术当天开始每天用FDP10g。于术前和术后第1、7d检测血浆清蛋白、前清蛋白、血磷，并做心电图。术后第1、3、5、7d测尿3-甲基组氨酸（3-MH），并计算氮平衡。结果：两组病人手术前、后血磷平均值正常，术后血清清蛋白和前清蛋白值较术前均降低，对照组前清蛋白水平下降明显（P〈0．05）。研究组术后尿3-MH排出较对照组明显减少（P〈0．05），术后累积氮平衡优于对照组（P〈0．05）。结论：FDP具有补磷、肠外营养增效及维护心功能的作用，适合老年腹部手术病人。

Objectives：To study the value of fructose-1, 6-diphosphate-supplemented parenteral nutrition in elder abdominal surgical patients. Methods： thirty-two patients were randomly allocated into study group and control group, receiving isocaloric （83.6 kJ/kg ·d^-1） and isonitrogenous （0.2 g/kg · d^-1 ） PN from post-operation day 1 to post-operation day 6. The study group received 10g of FDP every day and did not receive Glycophos. Plasma albumin, pre-albumin and phosphate lever were measured and EKG was examined before surgery and days 1 and 7 after surgery. The level of 3-methylhistidine （3- MH） in urine was measured and nitrogen balances were calculated postoperatively on day 1,3, 5 and 7. Results ： The blood phosphate levels were normal in two groups before and after surgery. Compared with preoperation, plasma albumin and pre-albumin levels were both decreased in two groups and pre-albumin level was markedly decreased in the control group （P 〈 0.05 ）. The urinary level of 3-MH in study group was significantly lower than that in control group （ P 〈 0. 05 ）.. Cumulative nitrogen balance in study group was significantly higher than that in control group （ P 〈 0.05 ）. Conclusion ： FDP is helpful in the elder abdominal surgical patient and helps to supply phosphate, to improve PN effect and to support heart function.