结构脂肪乳在高龄胃肠道肿瘤术后患者肠外营养的应用

Application of structured triglycerides for parenteral nutrition in elderly patientsafter gastrointestinal tumor surgery

目的：探讨结构脂肪乳在高龄胃肠道肿瘤术后患者肠外营养的应用。方法选择2012年1月至2014年10月在北京朝阳医院老年病房住院的经病理证实为胃肠道肿瘤的高龄术后患者68例，随机分为结构脂肪乳组（STG组）35例，对照组（MCT/LCT组）33例，分别给予肠外营养支持治疗。监测两组患者营养指标、脂代谢、糖代谢指标、肝酶、胆红素、超敏C反应蛋白（hs-CRP）及免疫指标变化。结果术前及术后治疗前，两组患者上述指标间差异均无统计学意义（P＞0.05）。进行6d等氮、等热量肠外营养支持治疗后，两组的TP、ALB、TC及STG组的PAB、MCT/LCT组的LDL-C显著高于治疗前（P＜0.05）。STG组营养指标显著高于MCT/LCT组同期水平（P＜0.05）；STG组TC、LDL-C显著低于MCT/LCT组同期水平（P＜0.05）。治疗3d后，STG组hs-CRP较治疗前显著降低（P＜0.05），且下降程度大于MCT/LCT组（P＜0.05）。治疗6d后，两组CD3^＋、CD4^＋均较治疗前明显升高（P＜0.05）；STG组CD3^＋、CD4^＋及CD4^＋/CD8^＋比值显著高于MCT/LCT组（P＜0.05）。治疗后两组糖代谢指标、肝酶、胆红素差异无统计学意义（P＞0.05）。结论结构脂肪乳对于胃肠道肿瘤术后高龄老年患者，在促进蛋白合成、维持血脂稳定、改善炎症反应及免疫抑制方面优于常规MCT/LCT，临床应用安全性较高。

ObjectiveTo determine theefficiency ofstructured triglycerides[STG, with the ratio of medium-chain triglyceridesto long-chain triglycerides （MCT/LCT）accounting for 36% to 64%] for totalparenteral nutrition（TPN） in theelderly patients with gastrointestinal（GI）tumor operation.MethodsSixty-eight elderlypathologically-identified GItumorpatientsundergoing surgical treatment and then beingadmitted to theDepartment ofGeriatrics of our hospital from January 2012 to October 2014 wererecruited in this study. Thecohort was randomly divided into2 groups, STG group （n=35） andMCT/LCT group （the ratio accounting for 50% to 50%,n=33）. They were all given TPN for 6 d after their operations. The parameters of nutrition, lipid metabolism, glucose metabolism, liver enzymes, bilirubin, high sensitivityC-reactive protein（hs-CRP） and immunologic profilesat baseline and 3and 6dafter treatmentwere measured and recorded respectively.ResultsTherewas nosignificantdifferencein the above-mentioned parameters betweenthe2 groups before and immediately after surgery. The levels of total protein （TP）, albumin （ALB） andtotalcholesterol （TC） in the both groups,that ofprealbumin （PAB） intheSTG group, andthat of low-density lipoprotein-cholesterol （LDL-C）inthe MCT/LCT group were significantly increasedafter 6 days’ isonitrogen isocaloric nutritional support （P〈0.05）.The nutritional parameters were significantly higher in the STG group thaninthe MCT/LCT group at the same time points （P〈0.05）, but the levels of TC and LDL-C were remarkably lower in the former thaninthe latter.At 3d after treatment, the level of hs-CRP was reduced significantly in STG group compared to that of before treatment （P〈0.05）, and the reduction was greater than that in the MCT/LCT group （P〈0.05）. The CD3^＋ and CD4^＋ cell counts were increasedsignificantly than before treatment in both groups （P〈0.05）, but the counts of CD3^＋ and CD4^＋ cells and the ratio of CD4^＋/CD8^＋ were much higher in the STG group thaninthepartner one （P〈0.05）. No statistical differencewasseen in glucose levels, liver function and bilirubin level between the 2 groups after treatment （P〉0.05）.Conclusion STGis superior to the conventional MCT/LCT in promoting protein synthesis, stabilizing lipid profiles, ameliorating the inflammatory reaction, as well as regulating theimmune system,forTPN intheelderly patientsafterGI tumor operation,andalso hashigher safetyin clinical application.