含α-维生素E的脂肪乳剂对外科患者抗氧化状态及脂质过氧化的影响

Lipid peroxidation and antioxidant status of surgical patients receivi ng TPN with an MCT /LCT emulsions supplemented withα-tocopherol

目的评价含α-维生素E(VitE)的中/长链脂肪乳剂在防止脂质过氧化和改善患者抗氧化状态中的作用。方法66例外科腹部手术患者随机分为3组,手术后第1天开始连续接受全肠外营养(TPN)7d。3组患者在等热卡、等氮(125.5kJ·kg-1·d-1;0.25gN·kg-1·d-1)的基础上,应用的脂肪乳剂分别为20%Intralipid(LCT组)、20%Lipofundin(MCT/LCT-E组)和含α-VitE的20%Lipofundin(MCT/LCT-E组)。于术前1d、术后第1天及第8天分别检测脂质过氧化的终产物丙二醛(MDA)和4-hydroxyalkenal,血浆α-tocopherol、VitC及无机硒浓度。结果经过1周TPN支持后,LCT组与MCT/LCT组患者的血浆MDA和4-hydroxyalkenal浓度明显高于MCT/LCT-E组。3组患者血浆α-tocopherol、VitC及无机硒浓度低于对照组,且手术后均明显下降。患者血浆α-tocopherol及无机硒浓度与血浆MDA和4-hydroxyalkenal浓度呈负相关(r1=-0.76,P=0.002;r2=-0.69,P=0.035)。研究结束时,MCT/LCT-E组血浆α-tocopherol及无机硒浓度明显高于另外两组。结论添加α-VitE的中/长链脂肪乳剂可降低脂肪乳剂输注所致的脂质过氧化,有效地维持或改善外科手术患者的抗氧化状态。

Objective To assess the effects of MCT /LCT lipi d emulsions supplemented withα-tocopherol on lipid peroxidation a nd antioxidant status.Methods Sixty-six patients after abdominal operations were randomly divided in to three groups,and received equal c alorie and nitrogen(125.5kJ·kg·d -1 ;0.25gN·kg -1 ·d -1 ),but different emulsions:20%Intra lipid,20%Lipofundinand 20%Lipofundinsupplemented withα-tocopherol content.The TPN regime n was delivered continuously over 7consecutive days.Plasma malondialdehyde(MDA),α-tocopherol,selenium and vitamin C were measured in the morning 1day preoperatively,1s t day and 8th day postoperatively.Results The concentrotions of plasma α-tocopherol,VitC and selenium were lower in the three groups than those i n the healthy control group,and decreased significantly after operations.After 7days of TPN infusion,the MDA and4-hydroxyalkenal concentrations were significantly higher in LCT grou p and MCT /LCT group than those in MCT /LCT-E group.The concentration s of plasma α-tocopherol and selenium were negatively correlated with plasma MDA and 4-hydroxyalkenal con centrations(r 1 =-0.76,P=0.002;r 2 =-0.69,P=0.035).The concentrations of plasma α-tocopherol and selenium in MCT /LCT-E group were significantly higher t han those in the other two groups.Conclusion MCT /LCT emulsions supplemented wit hα-tocopherol can decrease lipid peroxidation caused by lipid emulsions and effectively maintain and improve anti-oxidation status in surgical patients.[