术后脂肪乳剂短期输注与脂代谢变化关系的前瞻性临床研究  

A PROSPECTIVE CLINICAL STUDY ON POSTOPERATIVE LIPID METABOLISM WITH DIFFERENT FAT EMULSIONS

作　　者：顾岩[1,2] 吴肇汉[1,2] 郑云红 

机构地区：[1]上海医科大学中山医院外科 [2]上海医科大学药学院有机合成教研室

出　　处：《中国普外基础与临床杂志》1999年第2期92-95,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：SSPC科研基金

摘　　要：前瞻性地研究术后短期应用不含脂肪乳剂的肠外营养（ＰＮ）与含１０％及２０％脂肪乳剂的ＰＮ对行中等以上普外科手术患者血脂代谢的影响。将５６例患者随机分成对照组（ｎ＝１８）、１０％Ｉｎｔｒａｌｉｐｉｄ组（ｎ＝１９）及２０％Ｉｎｔｒａｌｉｐｉｄ组（ｎ＝１９），于术后接受５天ＰＮ支持。结果：术后１０％组血总胆固醇（Ｔｃｈｏ）及低密度脂蛋白胆固醇（ＬＤＬｃｈ）明显高于２０％组及对照组，增加的胆固醇以游离胆固醇（Ｆｃｈｏ）为主；异常脂蛋白（ＬＰＸ）及磷脂也均高于２０％组及对照组。本实验结果提示：脂肪乳剂中磷脂／甘油三酯（ＰＬ／ＴＧ）比值过高所产生的过剩磷脂是导致术后短期ＰＮ血Ｔｃｈｏ蓄积的主要原因，其中ＬＰＸ的形成起了重要的作用。与１０％Ｉｎｔｒａｌｉｐｉｄ相比，２０％Ｉｎｔｒａｌｉｐｉｄ对机体脂代谢影响较小，更适合于临床使用。To investigate prospectively the short term effect of different fat emulsions on plasma lipids and lipoproteins and to clarify the underlying mechanisms. Fifty six surgical patients were randomized to received intravenously either a 10%. Intralipid, a 20% Intralipid or no fat emulsions for 5 days postoperatively as part of a standard parenteral nutrition regimen. Serum lipids and lipoproteins were measured prior to and after the 5 day infusion period. Results: Intravenous administration of 10% Intralipid caused a marked increase of total cholesterol (Tcho), free cholesterol (Fcho), Low density lipoprotein cholesterol (LDL ch), phospholipid and lipoprotein X (LPX). Quantification of LPX revealed that its increase was proportionate to that of phospholipid and Tcho. Conclusion: Exogenous phospholipids when using fat emulsions with a high phospholipid/triglyceride (PL/TG) ratio play an impressive role in the formation of LPX and consequently are capable of inducing hypercholesterolemia after only a few days. Therefore, 20% Intralipid should be preferred to the corresponding 10% Intralipid for its low PL/TG ratio.

关 键 词：脂肪乳剂 术后 脂代谢 肠外营养 

分 类 号：R459.3[医药卫生—治疗学]