加用1,6-二磷酸果糖的全肠外营养对感染动物及危重病人的支持效果(英文)

Fructose-1,6-diphosphate-added total parenteral nutrition in septic animals and stressed patients

目的 比较加用 1,6 二磷酸果糖 (FDP)的全肠外营养及常规全肠外营养对危重应激机体的营养支持效果。方法 将 13条已经造成感染模型的犬分成两组。第一组为TPN组 (n =6 ) ,输入常规TPN液。第二组为加用 1,6 二磷酸果糖的实验组 (TPN +FDP组 ,n =7) ,在常规TPN液中加入每天每千克体重 1克FDP钠盐。在此基础上 ,对一组重症应激病人应用 1周TPN +FDP及常规TPN作比较研究。结果 在TPN +FDP组动物 ,经 2 4h ,4 8h支持后血浆ATP水平明显升高 (P <0 0 1) ,而在常规TPN组则变化不明显 ,两者相差也有显著意义。此外 ,肌肉中ATP及磷酸肌酸含量在TPN +FDP组也有显著升高。免疫组化技术发现在TPN +FDP组动物的骨骼肌内有大量细胞色素氧化酶颗粒。在临床病人的对比研究中 ,接受TPN +FDP的病人血中ATP升高、尿 3 甲基组氨酸排出量下降 ,正氮平衡明显加强。

Objective To investigate the roles of fructose-1,6-diphosphate(FDP)-added total parenteral nutrition (TPN)in septic animals and stressed patients.Methods Thirteen adult dogs were randomly assigned to one of two study groups 6 hours after the induction of severe intra-abdominal infection.Group TPN(n =6)received 70 kcal· kg-1· d-1 of nonprotein calorie(NPC)and 0.56 g· kg-1· d-1 of nitrogen.1 g/kg of FDP was also infused to the animals in group TPN + FDP(n = 7)everyday.In the clinical study,the control group received routine TPN,while the study group(n = 16)was treated with TPN plus FDP(5 g,two times a day)for 7 days.Results In dogs with TPN support,plasma ATP levels were not changed significantly,while the value in the TPN + FDP group increased significantly from 0.18 μmol/L to 0.46 μmol/L at 24 h and 0.51 μmol/L at 48 h(P ＜ 0.01).Muscular ATP increased markedly in the TPN + FDP group.Muscular creatine phosphate alues were not significantly changed in the TPN group,but the values increased in the TPN + FDP group from 4.06 μmol/g·wt at the beginning to 4.93 μmol/g· wt at 24 h and 5.60 μmol/g·wt at 48 h(P ＜ 0.05),with a cytochrome oxidase increase in immunohistochemistry stain.In the clinical study,plasma ATP levels increased and urinary 3-methylhistidine production significantly decreased with an improved value for positive accumulative nitrogen balance in the FDP-infused group.Conclusion Our results suggest that total parenteral nutrition support with the supplement of fructose-1,6-diphosphate has a positive role in body energy production and protein metabolism in septic animals and stressed patients.