结构脂肪乳剂改善腹部手术后病人的氮平衡和蛋白质代谢  

Parenteral structured triglyceride emulsion improves nitrogen balance and protein metabolism in traumatic patients after abdominal operations

作　　者：王新颖[1] 李宁[1] 罗楠[1] 邹志英[1] 江志伟[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2005年第5期272-275,共4页Parenteral & Enteral Nutrition

摘　　要：目的:观察结构脂肪乳剂(STG)和物理混合的中、长链脂肪乳剂(MCT/LCT)对腹部中等及中等以上手术创伤病人氮平衡和蛋白质代谢的影响。方法:腹部中等及中等以上手术病人随机分为两组,术后第2天开始分别使用STG和MCT/LCT构成的等氮、等热量肠外营养支持5天,术后第1天至第6天留取标本检测氮平衡,术前、术后第1天及术后第6天抽取静脉血检测血清前清蛋白水平,术前及术后第6天称取体质量,记录住院日。结果:围手术期使用STG和MCT/LCT的静脉营养,均可以纠正创伤病人的负氮平衡,促进血清前清蛋白的合成。其中STG可以更明显地改善手术创伤病人的负氮平衡,增加血清前清蛋白水平,但在维持病人体质量和缩短住院日上,STG与MCT/LCT脂肪乳相比差异并不明显。结论:在改善手术创伤病人的蛋白质代谢上,STG比物理混合的MCT/LCT脂肪乳剂更加优越。Objective： Most postoperative patients lose net protein mass, which reflects loss of muscle tissue and organ function. Perioperative parenteral nutrition may reduce the loss of protein, but in general, with conventional lipid emulsions a waste of protein still remains. Methods： We compared the effects on nitrogen balance of an emulsion containing structured triglyceride, a new type of synthesized triglycerides, with an emulsion of a physical mixture of medium- and long-chain triglycerides as part of parenteral feeding in moderately catabolic patients. The moderately abdominal operation patients received total parenteral nutrition（TPN） for first 5 days with 0.15 g of nitrogen and 20 kcal per kg body weight per day. The design was a randomized, double-blind parallel study. Results： In the patients who completed the study, the cumulative nitrogen balance for the first 5 postoperative days was （ 8.4 ± 2.0） g in STG group and （4.9 ± 2.4） g in MCT/LCT group. On the sixth postoperative day serum prealbumin levels increased more in patients of STG group than in MCT/LCT group. Conclusion： The parenteral STG emulsion improves the nitrogen balance and protein metabolism, compared with the emulsion of the physical mixture of medium- and long-chain triglycerides, in moderately catabolic patients.

关 键 词：结构脂肪乳剂 脂肪乳剂 氮平衡 蛋白质代谢 

分 类 号：R459.3[医药卫生—治疗学]