静脉脂肪乳剂在外科重症病人的应用

Application of intravenous lipid emulsions in surgical critically ill patients

半个世纪以来,静脉用脂肪乳剂一直是外科重症病人静脉营养必不可少的成分之一,构成糖脂双能源、提供必需脂肪酸并为脂溶性维生素提供溶质。然而,来源或结构不同的脂肪乳剂代谢途径与产物不同,对机体炎症和免疫有着不同的作用。应了解静脉用大豆油脂肪乳(SO)、中、长链脂肪乳(MCT/LCT)、结构脂肪乳(SLs)、鱼油脂肪乳(FO)、橄榄油脂肪乳(OO)和混合脂肪乳(SMOF)的代谢特点,不同来源的静脉脂肪乳剂可能对外科重症病人免疫及预后有不同的影响。

Intravenous lipid emulsions has been always an important part of parenteral nutrition in surgical critically ill patients for more than 50 years. Lipids constitute the dual-energy source with carbohydrates. It provides necessary fatty acids and the solution for lipid-soluable vitamines. However, lipids from different source have different structure and could have different biological activities, which could interfere the host defenses and inflammation. In this review, commonly used lipid emulsions including soybean oil derived lipids, coconut oil-based LCT/MCT, structured lipids （SLs）, fish oil （FO）, olive oil-based lipids （OO） and mixture of multiple lipids （SMOF） are discussed with their inflammatory potential and possible influence on surgical critically ill patients.