脂肪乳剂对重症胰腺炎患者凝血纤溶系统的影响  

Effect of Fat Emulsion on Hemostasis in Patients with Severe Acute Pancreatitis.

作　　者：曹伟新[1] 刘牧林[1] 尹浩然[1] 汤耀卿[1] 陈尔真[1] 邵慧珍[1] 

机构地区：[1]上海第二医科大学附属瑞金医院营养科,200025

出　　处：《外科理论与实践》1999年第3期152-156,共5页Journal of Surgery Concepts & Practice

摘　　要：了解应用脂肪乳剂对急性重症胰腺炎(SAP)患者凝血纤溶功能的影响。方法:25例SAP患者在分别应用含有长链脂肪酸(L)或中长链脂肪酸(M)的脂肪乳剂或无脂肪(对照)的肠外营养支持前后,测定其凝血及纤溶指标。结果:SAP时,患者抗凝血酶-Ⅲ活性降低,血小板α颗粒膜蛋白-140、血管性血友病因子水平升高,组织纤溶酶原激活物、纤溶酶原活性降低,纤溶酶原激活物抑制物、D-D二聚体升高。短期应用含有脂肪乳剂的TPN后,无论中长链或/和长链脂肪乳剂组,组织纤溶酶原激活物、血管性血友病因子的恢复均迟于对照组。结论:在SAP患者存在轻度凝血纤溶功能改变的情况下,短期适量的脂肪乳剂作为TPN中非蛋白热卡的一部分,对凝血功能的影响甚小。To elucidate the influence of fat emulsion on hemostasis in patients with severe acute pancreatitis(SAP). Methods: 25 cases of severe acute pancreatitis were randomly divided into three groups: (l)TPN without fat emulsion(group C, n=9);(2)TPN with fat emulsion containing long-chain tri-glycerides only (group L, n=8);(3)TPN with medium-/long-chain triglycerides(group M, n=8). A number of parameters reflecting the coagulation and fibrinolysis mechanism were detected before and after the nutritional support. Results: The activity of AT-Ⅲ, t-PA and Plg were decreased during the treatment; however, the levels of GMP-140, vWF, PAI and D-D were elevated. When fat emulsions were admini-stered, the recovery of t-PA and vWF became slower either in group L or in group M as compared to group C. Conclusions: Despite the ocurrence of a certain degree of damage in the mechanism of hemo-stasis fibrinolysis during the course of severe acute pancreatitis, fat emulsion, as a source of non-pro-tein energy in TPN, was safe and useful if administered during a short period.

关 键 词：胰腺炎 脂肪乳剂 凝血 纤溶系统 

分 类 号：R657.510.5[医药卫生—外科学] R459.3[医药卫生—临床医学]