肝脏外科患者术后输注脂肪乳剂对蛋白质代谢的影响

Influence of fat emulsion on protein metabolism of surgical patients with liver disease

将32例肝脏外科疾病患者随机分为Ⅰ组（单能源TPN组10例）；Ⅱ组（双能源TPN组11例，其中脂肪乳剂用量为1g·kg－1·d－1）；Ⅲ组（双能，TPN组11例，其中脂肪乳剂用量为2g·kg－1·d－1）。术后按组别给予TPN支持共6天，术前1天、术后第1和第6天测定肝功，糖代谢及蛋白质合成代谢指标。结果：①Ⅱ、Ⅲ组术后第6天肝脏酶学指标明显下降（P＜0．05），而Ⅰ组仍高于术前水平（P＜O．05）；②Ⅱ、Ⅲ组术后糖代谢基本恢复正常，而Ⅰ组出现高血糖症及高胰岛素血症（P＜0．05）；③Ⅱ组肝脏蛋白质合成水平恢复术前水平或略有提高（P＜0．05），而Ⅰ和Ⅲ组术后蛋白质合成功能仍低（P＜0．05）。结果提示：含脂肪乳剂的TPN支持对肝脏外科患者术后的肝功恢复有益，能促进蛋白质合成及肝细胞再生，并且在进行TPN支持时按1g·kg－1·d－1给予脂肪乳剂较为安全合理。

To evaluate the influence of fat emulsion on protein metabolism of surgical patients with liver disease. Method: thirty two patients were assigned to three groups: Group Ⅰ (n = 10), TPN without fat emulsion, Group Ⅱ(n = 11), TPN with fat emulsion, 1g· kg-1·d-1, and Group Ⅲ (n = 11 ),TPN with fat emulsion, 2 g· kg-1·d-1. All patients received TPN for 6 days postoperatively. Clinical chemistry parameters (hepatic function, glucose metabolism and protein metabolism) were measured preoperatively and on day 1 and day 6 postoperatively. Result: (1)Total bilirubin, ALT, AST on day 6 postoperatively decreased in Group Ⅰ and Group Ⅲ (P ＜0. 05), but increased in Group Ⅰ (P ＜ 0.05 ). (2)The blood glucose and insulin levels were normal in Group Ⅱ and Group Ⅲ, but increased in Group Ⅰ(P ＜ 0.05). (3)Serum albumin, transferrin and prealbumin levels increased in group Ⅱ (P ＜ 0. 05) butdecreased in Group Ⅰ and Group Ⅲ (P＜0. 05). Conclusion: (1 )TPN with fat emulsion could improve hepatic function, glucose and protein metabolism of surgical patients with liver disease. (2)The dosage of 1g·kg-1·d-1 of fat ernulsion was preferable to 2g· kg-1·d-1.