脂肪乳剂对梗阻性黄疸病人术后肝功能及脂代谢的影响  

The influence of fat emulsion on liver function and fatty metabolism in patients after surgery of obstructive jaundice

作　　者：贾乾斌[1] 吴言涛[1] 毛海香[1] 王波涌[1] 汤宇[1] 

机构地区：[1]华西医科大学附属第一医院,成都610041

出　　处：《中国临床营养杂志》1999年第3期112-114,共3页Chinese Journal of Clinical Nutrition

摘　　要：目的为了解输注脂肪乳剂对梗阻性黄疸病人术后肝功能及脂代谢影响。方法将36例梗阻性黄疸病人随机分为：Ⅰ组（n=25，10％和20％Lipovenous组），Ⅱ组（n=11，10％Intralipid组）术后经外周静脉营养支持，于术前、术后第3和6天测定肝功能及脂代谢指标。结果两组术后第6天肝脏酶学指标及胆红素均明显下降（P＜0.05），转铁蛋白、前白蛋白和动脉血酮体比率恢复至术前水平。两组术后TG、CH、LDL逐渐下降，但Ⅰ组LDL下降更明显（P＜0.05）。载脂蛋白（A1和B100）也逐渐下降，其中Ⅱ组apoA1下降更明显（P＜0.05）。卵磷脂胆固醇酰基转移酶活性于术后第6天基本恢复至术前水平，Ⅰ组血磷脂渐下降而Ⅱ组则呈明显上升趋势（P＜0.05）。结论梗阻性黄疸病人术后短期应用脂肪乳剂能促进肝脏蛋白质合成，不会加重肝功能损害和脂肛谢紊乱。输注低磷脂含量的脂肪乳剂对脂代谢影响较小，更适合此类病人能源的补充。Aim:This study was designed to investigated the effect of fat emulsion containing low phospholipid on liver function and fatty metabolism in the jaundiced patients after surgery due to extrahepatic duct obstruction. Methods:Thirty-six obstructive jaundiced patients were allocated randomly to two groups(G): Twenty-five patients in group Ⅰ received parenterally nutrition support with 10% or 20% Lipovenous since the first day after surgery,and the others in group Ⅱfeeded parenterally nutrients with 10 % Intralipid at same time.The blood samples were collected to determine the changes of liver function and lipid metabolism on the preoperative,the third and sixth day after surgery.Results:The level of serum bilirubin, aspartate transaminase and alanine transaminase in two groups reduced obviously(P< 0.05), and the transferrin, prealbumin and arterial ketone body ratio regained to the preoperative values on the sixth day after surgery, and the plasma triglyceride, cholesterols and LDL in both group decreased gradually, but the LDL in group Ⅰ was more obvious (P < 0.05) POStoperatively, and the apoprotains(aPoA1 and apoB100) also reduced gradually, but the apoA1 in group Ⅱreduced obviously(P < 0.05 ), the lecithin-cholesterol acyltransferase activity in both group recovered to the preoperative values on the sixth day,and plasma phospholipids in group Ⅰ was reduced but that in group Ⅱ was increased postoperatively (P<0.05 ). Conclusion:This study suggested that fat emulsion infused parenterally for a short time after surgery in patients suffering from obstructive jaundice was able to enhance hepatic protains synthesis, but not to deteriorate the damage of liver function and disorders of lipid metabolism,and the fat emulsion containing low phospholipid was more suitable energy source for the patients with obstructive jaundice and improves obviously their lipid metabolism.

关 键 词：脂肪乳剂 梗阻性黄疸病 肝功能 脂代谢 血磷脂 

分 类 号：R575[医药卫生—消化系统] R589.2[医药卫生—内科学]