加用1,6-二磷酸果糖的全肠外营养对严重感染动物及危重病人的支持效果

The roles of fructose 1,6 diphosphate added total pareteral nutrition——Results from an animal experiment and clinical study

目的：为比较加用１，６┐二磷酸果糖的全肠外营养（ＴＰＮ＋ＦＤＰ）及常规全肠外营养（ＴＰＮ）对危重应激机体的支持效果。方法：将已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ＴＰＮ＋ＦＤＰ组（ｎ＝７），常规ＴＰＮ液加用每天每公斤体重１克ＦＤＰ钠盐。对一组重症应激病人应用１周ＴＰＮ＋ＦＤＰ及常规ＴＰＮ作比较研究，连续５～７天。结果：ＴＰＮ＋ＦＤＰ组血、骨骼肌ＡＴＰ及肌肉磷酸肌酸、细胞色素氧化酶明显高于ＴＰＮ组。给予ＴＰＮ＋ＦＤＰ后，动物２４、４８、７２ｈ血浆ＡＴＰ值明显高于支持前水平（Ｐ＜０．０１）。同时，在２４、４８ｈ时，血浆ＡＴＰ值显著高于ＴＰＮ组（Ｐ＜０．０１）。第２４ｈ骨骼肌ＡＴＰ值（４．７６±０．９７μｍｏｌ／ｇｗｔ）明显高于ＴＰＮ组（３．５４±０．８５μｍｏｌ／ｇｗｔ，Ｐ＜０．０５）。在第２４、４８ｈ时ＣＰ含量明显高于ＴＰＮ组。ＣＣＯ染色颗粒明显增加，经彩色图像分析仪测定第４８ｈ及第７２ｈ骨骼肌ＣＣＯ染色颗粒相对密度值（６．０１±２．０３及６．４５±３．１８）较ＴＰＮ组（３．９７±１．８６及３．１０±１．９２）有明显升高（Ｐ＜０．０１）。结果表明ＴＰＮ＋ＦＤＰ支持组?

Objectives: To investigate the roles of fructose 1,6 diphosphate added total paretneral nutrition in septic animals and stressed patietns. Methods:Thirteen adult dogs were assigned randomly to one of three study groups 6 hours after the induction of severe intraabdominal infection by the infusion of living bacteria into the peritoneal cavity.Group TPN( n =6) received 293 kJ/(kg·d) of nonprotein calorie(NPC) and 0.56 g/(kg·d) of nitrogen and 1 g/kg of fructose 1,6 diphosphate (FDP,from Biomedica Foscoma,Italy).Serum ATP concentration,muscular ATP and creatine phosphate contents(CP) and cytochrome oxidase activity(CCO) were measured. Results: The results illustrated that with TPN support,the serum ATP levels were maintained as 0.13 μmol/L at the beginning,0.17 μmol/L at the 24th hour and 0.11 μmol/L at the 48th hour,while the values in group TPN+FDP increased significantly from 0.18 μmol/L to 0.46 μmol/L and 0.51 μmol/L,respectively( P <0.01).Same differences were noted in the values of ATP concentration in skeleton muscle.The muscular CP values were not changed significantly in group TPN,but increased in group TPN+FDP from 4.06 μmol/g at the beginning of the study,4.93 μmol/g at the 24th hour to 5.60 μmol/g the 48th hour( P <0.05).The CCO values in muscles were noted to be higher in group TPN+FDP than the values in group TPN( P <0.01).The mortality during 72 hours was 3/7 in group TPN and 2/6 in group TPN+FDP.In clinical study,we investigated the effects of exogenous FDP supplement in the stressed patients supported with TPN postoperatively.Thirty patients in our intensive care unit were divided into two infusion groups.The control group received routine TPN,while the study group( n =16) was fed intravenously with TPN plus FDP(5 g,two time a day) for 5 to 7 days.The results showed that in study group the serum levels of ATP increased and the urinary 3 methylhistidine production decreased significantly with a better accumulative nitrogen balance when compared to the control group. Conclusions:It is suggested that total parenteral nutrition support with the use of fructose 1,6 diphosphate has a positive role in the energy and protein metabolism in septic animals and stressed patients.