结构脂肪乳剂对胃肠肿瘤病人静息能量代谢和脂质过氧化的影响

The effect of structoglyceride on resting energy expenditure and lipid peroxidation in patients with gastrointestinal neoplasm

目的:观察结构脂肪乳剂(STG)和物理混合的中长链脂肪乳剂(MCT/LCT)对胃肠肿瘤病人静息能量代谢和脂质过氧化的影响。方法:对择期手术的胃肠道肿瘤病人64例,随机分为STG组和MCT/LCT组,于术后第2～6天分别使用STG和MCT/LCT构成的等氮、等热量PN支持,共5 d。术后第1至第6天检测病人静息能量代谢、氮平衡和血清超敏C-反应蛋白,术后第6天抽取静脉血行脂质过氧化水平检测。结果:两组病人术后静息能量代谢均较术前明显升高,STG组病人明显低于MCT/LCT组(P<0.05);两组病人采用STG和MCT/LCT的PN治疗后氮平衡均有改善,而STG组病人累计氮平衡值明显高于MCT/LCT组病人(P<0.05)。STG组病人血清中丙二醛和谷胱甘肽过氧化物酶水平亦明显低于MCT/LCT组(P<0.05)。结论:对胃肠肿瘤病人,在减轻脂质过氧化损伤和维护能量代谢稳定方面,STG比MCT/LCT更为优越。

Objective： To explore the effect of structoglyceride （STG） and medium/long-chain triglycerides （MCT/LCT） on resting energy expenditure and lipid peroxidation in patients with gastrointestinal neoplasm. Methods： Sixty four patients with gastrointestinal neoplasm were separated into two groups. All patients received total parenteral nutrition for first 5 days. REE, nitrogen balance, hypersensitive C-reactive protein and lipid peroxidation were examined after operation. Results： The REE of two groups was significantly increased after operation and it was higher in STG group than in MCT/LCT group （ P 〈 0.05 ）. The cumulative nitrogen balance for five postoperative days was （ 8.5 -＋ 2.0） g in STG group and （4.9 ＋- 2.3 ） g in MCT/LCT group. The MDA level of STG group was significantly less than the MCT/ LCT group （ P 〈 0.05 ）. Moreover, the GSH-Px level of STG group was significantly less than the MCT! LCT group （ P 〈 0.05 ）. Conclusion ： The parenteral STG emulsion may cause less lipid peroxidation and metabolic disorder than MCT/LCT in patients with gastrointestinal neoplasm.