含橄榄油脂肪乳剂在食管癌患者术后肠外营养中的应用

Olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy

目的 研究含橄榄油脂肪乳剂在食管癌术后肠外营养支持中应用的安全性和有效性。方法60例胸段食管癌根治术患者用SPSS软件产生的随机数字分为对照组（n=30）和研究组（n=30），两组患者术后进行7～10d的肠外营养支持，采用等氮、等热量、等渗透压、等液体量配方。研究组使用含橄榄油脂肪乳剂，对照组使用中／长链脂肪乳剂。所有患者分别于术前及术后第1天、第8天清晨空腹抽取外周静脉血送检。观测指标：术前营养状态及营养风险评估，包括体重、体重指数、营养风险筛查等；安全性指标，包括血常规、血电解质、谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素、结合胆红素、尿素氮（BUN）、肌酐、血糖等；有效性指标，包括血红蛋白、白蛋白、总蛋白等。结果两组术后第8天的白蛋白及总蛋白值均在正常范围内，但研究组的测量值较对照组高（P=0．000），且研究组术后第8天与第1天的总蛋白差值较对照组高（P=0．002）。术后第8天对照组的AST及BUN值升高，而研究组的AST及BUN均在正常范围且明显低于对照组（P=0．025，P=0．013）。两组间在生命体征变化、不良事件发生率、血常规、血电解质、血糖、血脂等方面差异无统计学意义（P均〉0．05）。结论含橄榄油脂肪乳剂在食管癌术后肠外营养支持中的应用是安全有效的；相对于中／长链脂肪乳剂而言，其对AST及BUN的影响较小。

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy. Methods In the randomized controlled trial, 60 patients undergoing esophagectomy were divided into study group （n = 30, received olive oil-based lipid emulsion） and control group [n=30, received medium-chain triglyceride/long-chain triglyceride （MCT/LCT） emulsion]. The parenteral nutrition was provided for 7-10 postoperative days. The nutritional formulas were equivalent in nitrogen, calorie, osmotic pressure, and fluid volume. Peripheral venous blood tests were performed before operation and on the first and eighth postoperative days. All the patients were evaluated by nutritional status （ weight, body mass index, nutritional risk screening, etc. ）, safety profiles I full blood test, electrolytes, aspartate aminotransferase （AST）, alaMine amiotransferase （ALT）, total bilirubin and direct bilirubin, blood urea nitrogen （BUN）, creatinine, blood glucose, etc. ], and efficacy indicators （hemoglobin, albumin, total protein, etc. ）. Results The albumin and total protein levels returned to the normal ranges in both groups 8 days after operation, although both levels were significantly higher in study group （ P = 0. 000）. Also, the difference of total protein levels between the eighth and first postoperative days was significantly higher in the study group （P =0. 002）. In addition, the AST and BUN readings returned to normal ranges 8 days after operation in the study group, which were significantly lower than those in control group （P = 0. 025, P = 0. 013 ）. No serious adverse events were reported in both groups. Other nutritional parameters, renal and hepatic safety profiels, vital signs, and hematology showed no significant difference between two groups. Conclusions Olive oil-based lipid emulsion is a safe and efficient lipid emulsion for parenteral nutrition in patients undergoing esophageetomy. Compared with MCT/LCT, it has less effect on AST and BUN.