结构脂肪乳剂对MODS患者蛋白质代谢的影响

Effect of structured triglyceride on the protein metabolism of MODS patients

目的:观察结构脂肪乳剂(STG)和中/长链脂肪乳剂(MCT/LCT)对多器官功能障碍综合征(MODS)患者氮平衡和蛋白质代谢的影响。方法:选取2012年9月–2013年2月入住我院ICU的MODS患者,共计40例。采用随机分组方法分为STG组(n=20)和MCT/LCT组(n=20),两组患者均接受等氮、等热卡的肠外营养治疗。患者每日所需热卡量按20 kcal·kg-1计算,氮入量以每日0.2 g·kg-1计算。全肠外营养(TPN)治疗前及治疗后第1、3、7天分别留取标本检测氮平衡、血清前清蛋白水平,并统计两组肠外营养治疗时间。结果:两组患者在TPN治疗前、治疗后第1天均存在明显的负氮平衡,第7天STG组患者累计氮平衡值为(7.2±2.0)g,明显高于MCT/LCT组(4.0±2.1)g。两组患者在TPN治疗前、治疗后第1天血清前清蛋白水平均较低,第7天STG组血清前清蛋白水平为(304.7±34.9)mg·L-1,明显高于MCT/LCT组(261.3±32.8)mg·L-1。STG组TPN治疗时间为(12.5±2.4)d,MCT/LCT组为(15.8±2.3)d,STG组明显低于MCT/LCT组。结论:STG可明显地改善MODS患者的负氮平衡,增加血清前清蛋白水平,缩短TPN治疗时间,在改善MODS患者的蛋白质代谢方面,STG比物理混合的MCT/LCT脂肪乳剂更加优越。

Objective： To investigate the effect of structured triglyceride （STG） and MCT/LCT on the nitrogen balance and protein metabolism of patients with multiple organ dysfunction syndrome （MODS）. Methods：A total of 40 MODS patients admitted to our hospital from September 2012 to February 2013 were collected and divided into STG group （n=20） and MCT/LCT group （n=20）. Both groups received parenteral nutrition treatment of equal nitrogen and calories. The daily calories were required as 20 kcal·kg^-1, and the daily requirement of nitrogen was calculated as 0.2 ·kg^-1. Specimens were collected and tested for the balance of nitrogen and the level of serum prealbumin before TPN treatment and on the 1st, 3rd and 7th day after TPN treatment, and the treatment time of parenteral treatment was counted. Results：On the 1st day both before and after the TPN treatment, both groups showed obvious negative nitrogen balance. On the 7th day the cumulative nitrogen balance value of the STG group was （7.2 ± 2.0） g, which was obviously higher than that of the MCT/LCT group （4.0 ± 2.1） g. On the 1st day both before and after the TPN treatment, both groups had low levels of serum prealbumin. On the 7th day the serum prealbumin level of the STG group was （304.7 ± 34.9） mg·L^-1, which was obviously higher than that of the MCT/LCT group （261.3 ± 32.8） mg·L^-1. The treatment time of TPN in the STG group was （12.5 ± 2.4） d, which was obviously lower than that of the MCT/LCT group （15.8 ± 2.3） d. Conclusion： The STG could obviously improve the nitrogen balance, increase the level of serum prealbumin, while reduce the treatment time of TPN in MODS patients. On the aspect of improving the protein metabolism of the MODS patients, STG was much better than the physically mixed MCT/LCT fat emulsions.