输入不同链长的脂肪乳剂后血中酮体的动态观察

The Kinetic Observation of Serum Ketone Body Levels in Surgical Patients Receiving MCT or LCT Emulsions

应用酶促法研究了输入不同链长的脂肪乳剂后病人血中酮体的变化。其中第一组8例病人接受输入剂量为0.14g/kg.h的中链或长链脂肪乳剂的廓清实验,第二组的12例病人在肠外营养(total parenteral nutrition,TPN)接受输入剂量为0.06g/kg.h的中链或长链的脂肪乳剂。而且还测定了30例正常人(男女各15例)血清β-羟丁酸的含量。研究结果,表明中链脂肪乳剂在廓清剂量时,血中酮体高于正常水平,而在常规胃肠外营养支持时,中链脂肪乳剂或长链脂肪乳剂均无血酮体升高现象,在临床上应用是安全的。

The changes of serum β-hydroxybutyrate concentrations in patients after receiving medium chain triglycerides (MCT) or long chain triglycerldes (LCT) were studied. The patients were divided into two groups, in Group 1, the dose of fat was 0.14g/kg·h for fat emulsion clearance test, and in Group 2, the dose was 0.06g/kg·h for total parenteral nutrition (TPN) support.The β-hydroxybutyrate concentrations were estimated by an enzymatic method using Sigma's β-hydroxybutyrate kit (Sigma Diagnostics, MO 63178, USA). The normal range of P-hydroxybutyrate concentration in 30 healthy Chinese subjects was 1.04 ± 1.42mg/dl (range 0-3.88mg/dl) .In Group 1, we found that the concentrations of β-hydroxybutyrate, , rose steadily after fat emulsion infusion. The concentrations in the medium chain: triglyceride group were higher than those in long chain triglyceride group. The elevated concentrations of P-hydroxybutyrate gradually returned to normal levels when the emulsion infusion was stopped. In Group 2 the concentrations, of β-hydroxybutyrate in the patients were within the normal range.