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结构脂肪乳在严重出血性休克复苏后患者肠外营养的应用 被引量:7

Applied studies of structured trigiycerides for parenteral nutrition in severe hemorrhagic shock patients after resuscitation
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摘要 目的比较结构脂肪乳与MCT/LCT物理混合脂肪乳在严重出血性休克复苏后患者肠外营养中的应用效果。方法数字随机对照选取2009年8月至2011年7月解放军总医院肝胆外科收治的20例围手术期出血量〉3000ml的重危患者为研究对象,患者数字随机等分为两组:A组(n=10)使用结构脂肪乳,B组(n=10)使用MCT/LCT物理混合脂肪乳。两组患者一般情况比较无明显差异。手术后第3天开始使用脂肪乳剂,至少使用5d。于使用脂肪乳前(dO)及使用后第1天(d1)、第3天(d3)、第5天(d5)抽血检测血红蛋白、血小板、丙氨酸转氨酶(ATJT)、胆红素、甘油三酯、前白蛋白、转铁蛋白等指标。记录同一时问点的平均动脉压、心率和中心静脉压。比较两组患者使用脂肪乳后上述指标的变化。结果两组患者使用脂肪乳后平均动脉压、心率、中心静脉压和血红蛋白、血小板差异无统计学意义(P〉0.05)。使用脂肪乳后第3天和第5天B组甘油三酯[(2.1±0.4)、(2.3±0.7)mg/L]、ALT[(133±58)、(1164-48)U/L]高于A组[(1.6±0.6)、(1.5±0.3)mg/L;(97±26)、(77±31)U/L)](P〈0.05),胆红素差异无统计学意义(P〉0.05)。使用脂肪乳后第3天和第5天A组血清前白蛋白[(195±55)、(245±53)mg/L]、转铁蛋白[(2.6±0.5)、(3.3±0.8)g/L]等营养指标高于B组[(166±55)、(195±58)mg/L]、转铁蛋白[(2.54-0.6)、(2.9±0.6)g/L](P〈0.05)。结论在严重出血性休克患者复苏后肠外营养中使用结构脂肪乳脂代谢、蛋白质合成和肝细胞保护优于MCT/LCT物理混合脂肪乳。 Objective To evaluate the effects of structured triglycerides in parenteral nutrition versus a physical medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) mixture on severe hemorrhagic shock patients after resuscitation. Methods In a randomized trial, we studied 20 critical patients with a total blood loss of over 3000 ml perioperatively and/or intraoperatively. The use of triglycerides started from Day 3 postoperation and parenteral nutrition lasted for no less than 5 days. They were allocated to receive one of two nutrition regiments: structured triglycerides in Group A (n = 10) and MCT/LCT in Group B (n = 10). There were no significant differences of general conditions in two groups. Before the start of parenteral nutrition (dO), dl d3 and d5 after start of infusion, the following parameters were measured: hemoglobin (Hb), platelet count (Pit), alanine aminotrasferase (ALT), total bilirubin (TB), direct bilirubin (DB), serum triglycerides (TG), prealbumin (PA) and transferrin (TF). And mean artery pressure ( MAP), heart rate (HR) and central vein pressure (CVP) were also recorded at the same time-points. Then the post-TG changes of the above data were compared in both groups. Results After the use of trig|ycerides, there were no significant differences of MAP, HR, CVP, Hb and Pit in both groups(P 〉0. 05). At D3 and D5, the serum levels of TG( 2. 1 ± 0.4) vs ( 1.6 ±0. 6) mg/L, (2. 3 ± 0. 7) vs (1.5±0. 3) mg/L)'and alanine aminotranferase( 133 ± 58) vs (97±26) U/L; ( 116±48) vs (77 ± 31 ) U/L)were significantly higher in Group B versus those receiving structured triglycerides in Group A ( P 〈 0. 05 ). TB ( 18± 15 ) vs ( 18 ± 11 ) μmol/L) and DB ( (8. 9 ± 3.2) vs (8.8 ±2. 5 ) μmol/L) had no significant differences in two groups ( P 〉 0.05 ). The serum levels of such nutrition markers as PA ((195±55) vs (166±55) mg/L, (245 ±53) vs (195 ±58) mg/L)and TF((2.6 ±0.5) vs (2.5 ± 0. 6) g/L, (3.3 ±0. 8) vs (2. 9±0. 6) g/L)were significantly higher in Group A than those in Group B (P 〈0.05). Conclusion With regards to lipid metabolism, protein synthesis and hepatocyte protection, structured triglycerides in parenteral mutrition is advantageous to standard MCT/LCT emusion in severe hemorrhagic shock patients after resuscitation.
出处 《中华医学杂志》 CAS CSCD 北大核心 2012年第12期827-830,共4页 National Medical Journal of China
基金 军队“十一五”保健专项基金(08BJ01) 解放军总医院科技创新苗圃基金(06MP45)
关键词 脂肪乳剂 静脉注射用 胃肠外营养 休克 出血性 Fat emulsions, intravenous Parenteral nutrition Shock, hemorrhagic
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