双能源肠道外营养对肝脏外科病人术后作用的研究  

Influence of fat emulsion on lipid metabolism of surgical patients with liver disease

作　　者：严律南[1] 李缨来[1] 郑朝旭[1] 彭斌[1] 刘占培[1] 吴红斌[1] 汤宇[1] 

机构地区：[1]华西医科大学附属第一医院普外科,成都610041

出　　处：《中华临床营养杂志》1997年第3期104-108,共5页Chinese Journal of Clinical Nutrition

摘　　要：将32例肝脏外科患者随机分为：Ⅰ组（对照组，n＝10，仅给予葡萄糖及氨基酸）、Ⅱ组（低脂组，n＝11，脂肪乳剂用量为1g·kg-1·d-1）和Ⅲ组（高脂组，n＝11，脂肪乳剂用量为2g·kg-1·d-1），术后按组别给予PN支持。分别测定术前1天，术后第6天肝功、糖代谢、脂代谢和能量代谢等各项指标。结果：①Ⅱ、Ⅲ组术后第6天肝脏酶学指标明显下降（P＜0．05），Ⅰ组仍高于术前；②Ⅱ、Ⅲ组术后糖代谢迅速恢复正常，而Ⅰ组出现高血糖及高胰岛素血症；③Ⅱ组血清脂质、脂蛋白、载脂蛋白水平及LCAT活性于术后第6天基本恢复正常（P＜0．05），而Ⅰ、Ⅲ组仍有异常。结果提示：含有脂肪乳剂的双能源PN支持对肝脏外科患者术后的肝功恢复有益，其合理剂量为1g·kg-1·d-1。Thirty two surgical patients with liver disease were studied. All of them were divided into three groups randomly to be given different kinds of TPN during the postoperative period group Ⅰ (TPN without fat emulsion), group Ⅱ (TPN with fat emulsion, 1g· kg-1 ·d-1 of fat), group Ⅲ (TPN with fat emulsion, 2g·kg-1· d-1 of fat ). Their liver function test, glucose, lipid metabolism and ketone body ratio (KBR) were examined and compared during the period of TPN.Result: ①TB, ALT, AST were decreased in group Ⅱ and group Ⅲ (P < 0. 05 ), but increased in group Ⅰ (P < 0. 05). ②The blood glucose, insulin levels were normal in group Ⅱ and group Ⅲ, but in group Ⅰ appeared hyperglycemia and hyperinsulinemia(P <0.05 ). ③The serum lipid, lipoprotein level and LCAT activity wer increased to normal level in group Ⅱ (P < 0. 05 ), but abnormal in group Ⅰ and group Ⅲ (P <0. 05 ). ④The ketone bodies ratio (KBR) decreased rapidly after operation immediately (0. 4～0. 7) then increased to normal range (>0. 7) during the period of TPN, espesially in group Ⅱ.Conclusion: ①Admistration TPN with fat emulsion for to surgical patients with liver diseases can make more improvement on hepatic energy metabolism than TPN without fat emulsion. ②1g·kg-1·d-1 of fat dosage maybe suitable for the patients during the period of postoperative TPN.

关 键 词：肠道外营养 脂肪乳剂 肝脏外科 肝脏能量代谢 

分 类 号：R459.3[医药卫生—治疗学]