肝移植术后病人应用鱼油脂肪乳的临床研究  

The application of fish oil lipid emulsion in patients undergoing liver transplantation

作　　者：江涛[1] 王轩[1] 张冬华[1] 陆雷[1] 张荣生[1] 张斌[1] 李增才[1] 贾绍昌[1] 

机构地区：[1]解放军第八一医院南京军区肝移植中心,江苏南京210002

出　　处：《肠外与肠内营养》2011年第6期322-325,共4页Parenteral & Enteral Nutrition

基　　金：南京军区面上项目(08MA050)

摘　　要：目的:探讨鱼油脂肪乳在肝移植术后的临床应用及其对预后的影响。方法:将36例肝移植术后病人随机分为鱼油组和对照组,每组18例。术后第2天开始给予等氮等热量的营养支持,共6 d,其中鱼油组ω-6/ω-3比值为2∶1,对照组为7∶1。病人分别于术前、术后第2、5、8天抽血检测肝肾功能、血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和C反应蛋白(CRP)等;观察和记录术后入住ICU时间、术后住院时间、急性排斥反应发生率、感染发生率和病死率等。结果:鱼油组病人术后肝肾功能改善更快。术后第5天TF、术后第8天PA、TC和HDL-C均显著高于对照组(P<0.05)。术后第5天CRP迅速降低,两组比较差异非常显著(P<0.01)。鱼油组病人术后入住ICU时间和住院时间显著短于对照组(P<0.05),感染发生率也显著降低(P<0.05)。两组急性排斥反应发生率无显著性差异(P>0.05)。结论:肝移植术后添加合适比例的鱼油脂肪乳,有利于器官功能的恢复,减少感染发生率,而不增加急性排斥反应的发生率,有利于病人预后。Objective： To explore the effect of fish oil lipid emulsion on the liver and kidney function,nutritional status and prognosis in patients undergoing liver transplantation.Methods： 36 patients were prospectively randomized to fish-oil group or control group（standard parenteral nutrition）.All Patients received isocaloric[25kcal/（kg·d）]and isonitrogenous[protein 1.5 g/（kg·d）]nutrition for 6 days after the operation.The serum levels of total bilirubin（TBIL）,direct bilirubin（DBIL）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,blood urea nitrogen（BUN）,creatinine（CR）,albumin（ALB）,prealbumin（PA）,transferin（TF）,triglyceride（TG）,total cholesterol（TC）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C） and C-reactive protein（CRP） were measured on preoperation and the 2nd,5th,and 8th postoperation day（POD） respectively.The incidence rate of infection and acute rejection,mortality,the ICU stay and hospital stay of each group were compared.Results： The improvement of liver and kidney function in the fish-oil group were more rapidly.The serum levels of TF（POD5）,PA（POD8）,TC（POD8） and HDL-C（POD8） of the fish-oil group were significantly higher than the control group（P0.05）.CRP level of the fish-oil group droped more significantly on the 5th POD（P0.01）.The incidence rate of infection（16.7%） of the fish-oil group was significantly lower than the control（55.6%）（P=0.035）,while the incidence rate of acute rejection had no significant difference between the two groups.Conclusion：The application of fish oil lipid emulsion in patients undergoing liver transplantation can improve liver and kidney function,reduce inflammation,lower the incidence rate of infection and be beneficial to prognosis.

关 键 词：肝移植 鱼油脂肪乳 炎症 预后 

分 类 号：R657.3[医药卫生—外科学]