结构脂肪乳与中/长链脂肪乳对胰十二指肠切除术后病人肝功能、蛋白质代谢、细胞免疫功能及临床不良反应的影响

Effect of structured fat emulsion and medium and long chain fat emulsion on liver function,protein metabolism,immunologic function and side effects in patients with pancreaticoduodenectomy

目的观察结构脂肪乳与中/长链脂肪乳对行胰十二指肠切除术后病人肝功能、蛋白质代谢、免疫细胞及临床不良反应的影响。方法胰十二指肠切除术后病人70例,将其分为实验组和对照组,每组各35例,实验组用结构脂肪乳,对照组用中/长链脂肪乳,比较两组病人治疗前后肝功能、蛋白质代谢、细胞免疫功能指标及临床不良反应的不同。结果 (1)两组病人肝功能指标在肠外营养支持后第一天即有明显升高(P<0.05),但对照组的上升速度明显快于实验组,差异有统计学意义(P<0.05)。其中,对照组在营养支持后第4天,总胆红素仍高于术前水平,且下降速度较慢,而实验组于支持后第3天则已降至正常水平,两组比较差异有统计学意义(P<0.05)。(2)两组病人营养支持前蛋白质水平比较差异无统计学意义,在使用脂肪乳后两组病人蛋白质水平均呈先下降再上升趋势,脂肪乳使用第5天两组蛋白质水平均恢复术前水平,其中实验组蛋白质上升水平明显高于对照组蛋白质上升水平,两组比较差异有统计学意义(P<0.05)。(3)比较两组病人CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平较输注前均有明显提高,但实验组上升趋势明显快于对照组,两组比较差异有统计学意义(P<0.05)。(4)实验组与对照组恶心呕吐的发生率分别为(11.84±5.06)%和(34.69±3.84)%,两组比较差异有统计学意义(P<0.05)。结论胰十二指肠术后短时间应用结构脂肪乳较中/长链脂肪乳的不良反应小,病人肝功能恢复快,提高机体免疫力,改善营养状况。

Objective To investigate the effect of structured fat emulsion and medium and long chain fat emulsion on liver function,protein metabolism,immunologic function and clinical side effects in patients with pancreeaticoduodenectomy.Methods A total of 70 patients who underwent the pancreatioduodenectomy were randomly divided into the experimental group and the control group,with 35 cases in each.The experimental group was received structured fat emulsion and the control group was received medium and long chain fat emulsion,the indicators described above collected before and after treatment was analyzed.Results Indicators of liver function after parenteral nutrition in two groups was statistically different（P〈0.05）;protein level after giving fat emulsion in two groups were also statistically different（P〈0.05）;the immunologic function（CD3~＋,CD8~＋,CD4~＋/CD8~＋counts）after structured fat emulsion injection was obviously elevated,comparing with the control group（P〈0.05）;the incidence of nausea and vomiting in the experimental group（11.84±5.06）% and the control group（34.69±3.84）% was statistically different（P〈0.05）.Conclusion The application of structured fat emulsion after pancreatioduodenectomy can promote the recovery of liver function and immunity,improve nutritional status and produce smaller side effects comparing with that of medium and long chain fat emulsion.It is safe and effective,and good for recovery.