Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life.Parenteral nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal failure...Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life.Parenteral nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal failure.Lifelong PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with malabsorption.However,prolonged PN is associated with short-term and long-term complications.Parenteral nutrition-associated liver disease(PNALD)is one of the long-termcomplications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients.PNALD affects 30–60%of the adult population on long-term PN.Further,PNALD is one of the indications for isolated liver or combined liver and intestinal transplantation.There is no consensus on how to manage PNALD,but fish oil-based lipid emulsion(FOBLE)has been suggested to play an important role both in its prevention and reversal.There is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid emulsion.Studies have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN.Future prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.展开更多
目的:探讨鱼油脂肪乳肠外辅助治疗重症胰腺炎的临床疗效。方法:选取60名重症胰腺炎(SAP)患者进行随机、双盲对照的临床试验。对照组(n=30)给予常规治疗,研究组(n=30)将结构脂肪乳替换为鱼油脂肪乳,余治疗方案相同。主要观察并比较两组...目的:探讨鱼油脂肪乳肠外辅助治疗重症胰腺炎的临床疗效。方法:选取60名重症胰腺炎(SAP)患者进行随机、双盲对照的临床试验。对照组(n=30)给予常规治疗,研究组(n=30)将结构脂肪乳替换为鱼油脂肪乳,余治疗方案相同。主要观察并比较两组患者实验室检查指标,临床病情严重度。同时观察并比较两组患者ICU及总平均住院日。结果:对照组在第5 d白介素-6(IL-6)(P=0.038)及肿瘤坏死因子-α(TNF-α)(P=0.019)水平明显降低,研究组在第5 d IL-6(P=0.018)及TNF-α(P=0.011)水平显著降低。对照组在第5 d降钙素原(PCT)(P=0.032)水平下降明显,研究组在第3 d PCT(P=0.018)水平即明显降低。对照组在第5 d CD4+的比率(P=0.033)和CD4+/CD8+比值(P=0.021)明显升高,研究组在第5 d CD4+的比率(P=0.017)和CD4+/CD8+比值(P=0.007)明显升高。研究组急性生理学与慢性健康状况评分(APACHEⅡ)减分率在第3 d(P=0.004)、第5 d(P=0.022)和第7 d(P=0.035)显著降低,APACHE Ⅲ评分(P=0.021)和简化急性生理学评分(SAPS Ⅱ) Ⅱ(P=0.017)减分率在第7 d显著降低。而平均重症监护病房(ICU)天数、平均住院天数比较差异无统计学意义(P>0.05)。结论:鱼油脂肪乳剂辅助治疗SAP是安全的,有助于减轻机体炎症反应和改善SAP的预后。展开更多
文摘Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life.Parenteral nutrition(PN)is a lifesaving therapeutic modality for patients with intestinal failure.Lifelong PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with malabsorption.However,prolonged PN is associated with short-term and long-term complications.Parenteral nutrition-associated liver disease(PNALD)is one of the long-termcomplications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients.PNALD affects 30–60%of the adult population on long-term PN.Further,PNALD is one of the indications for isolated liver or combined liver and intestinal transplantation.There is no consensus on how to manage PNALD,but fish oil-based lipid emulsion(FOBLE)has been suggested to play an important role both in its prevention and reversal.There is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid emulsion.Studies have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN.Future prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD.
文摘目的:探讨鱼油脂肪乳肠外辅助治疗重症胰腺炎的临床疗效。方法:选取60名重症胰腺炎(SAP)患者进行随机、双盲对照的临床试验。对照组(n=30)给予常规治疗,研究组(n=30)将结构脂肪乳替换为鱼油脂肪乳,余治疗方案相同。主要观察并比较两组患者实验室检查指标,临床病情严重度。同时观察并比较两组患者ICU及总平均住院日。结果:对照组在第5 d白介素-6(IL-6)(P=0.038)及肿瘤坏死因子-α(TNF-α)(P=0.019)水平明显降低,研究组在第5 d IL-6(P=0.018)及TNF-α(P=0.011)水平显著降低。对照组在第5 d降钙素原(PCT)(P=0.032)水平下降明显,研究组在第3 d PCT(P=0.018)水平即明显降低。对照组在第5 d CD4+的比率(P=0.033)和CD4+/CD8+比值(P=0.021)明显升高,研究组在第5 d CD4+的比率(P=0.017)和CD4+/CD8+比值(P=0.007)明显升高。研究组急性生理学与慢性健康状况评分(APACHEⅡ)减分率在第3 d(P=0.004)、第5 d(P=0.022)和第7 d(P=0.035)显著降低,APACHE Ⅲ评分(P=0.021)和简化急性生理学评分(SAPS Ⅱ) Ⅱ(P=0.017)减分率在第7 d显著降低。而平均重症监护病房(ICU)天数、平均住院天数比较差异无统计学意义(P>0.05)。结论:鱼油脂肪乳剂辅助治疗SAP是安全的,有助于减轻机体炎症反应和改善SAP的预后。
