Lipoplus脂肪乳对胃肠恶性肿瘤患者术后营养状况和早期炎性反应的影响  

Influence of Lipoplus fat emulsion on postoperative nutritional status and early inflammatory response in patients with gastrointestinal malignancies

作　　者：张才华[1] 李宁[1] 王新颖[1] 李国立[1] 范朝刚[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院解放军普通外科研究所,210002

出　　处：《中华胃肠外科杂志》2012年第5期448-451,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的观察Lipoplus（力保加）脂肪乳对胃肠肿瘤患者术后营养状况和早期炎性反应的影响。方法前瞻性人组2010年4月至2011年4月南京军区南京总医院普通外科收治的64例胃肠道肿瘤患者．按随机数字表法随机分为Lipoplus组和Lipofundin（力保肪宁）组，每组32例。术后1．5d，两组患者按等氮、等热量进行肠外营养支持。于术前及术后1、2、3、6d，检测营养指标（前白蛋白、视黄醇结合蛋白和氮平衡）和炎性反应指标[c反应蛋白和白细胞三烯（LTB5和LTB4）]；并观察患者术后全身炎性反应综合征（SIRS）、感染发生率、病死率、APACHEⅡ评分及术后住院时间等临床指标。结果术后1d．两组患者前白蛋白和视黄醇结合蛋白水平较术前明显降低：术后6d又明显升高（P〈0．05）．并已达到正氮平衡。术后6d，两组患者C反应蛋白水平较术后3d明显下降（P〈0．05），且Lipoplus组较Lipofundin组下降趋势更为明显（P〈0．05）：Lipoplus组LTB5／LTB4较术后1d明显升高（P〈0．05），但Lipofundin组LTB5／LTB4的升高却未达到统计学意义（p〉0．05）。Lipoplus组术后感染发生率（3．1％，1／32）和SIRS发生率（6．3％，2／32）低于Lipofundin组『分别为9．4％（3／32）和15．6％（5／32）]，APACHEⅡ评分（3．6±2．0）高于Lipofundin组（3．3±2．1），但差异均无统计学意义（均P〉0．05）；Lipoplus组术后住院时间则较Lipofundin组明显缩短[（6．4±1．1）d比（8．2±1．3）d，P〈0．05]。结论Lipoplus脂肪乳剂可显著改善胃肠肿瘤患者术后营养状况并降低术后炎性反应。Objective To investigate the effect of Lipoplus on postoperative nutritional status and inflammatory response in patients with gastrointestinal malignancies. Methods Sixty-four patients with gastrointestinal malignancies were randomized using random digit table to receive isonitrogenous, isocaloric total parenteral nutrition for 5 days including either Lipoplus or Lipofundin with 32 patients in each group. Blood samples were obtained before the surgery, postoperative days 1, 2, 3, and 6 to evaluate the nutritional status （prealbumin, retinol binding protein, and nitrogen balance） and inflammatory response [C-reaction protein（CRP）, and leukotriene（LTB）5, LTB4]. The incidence of postoperative systemic inflammatory response syndrome （SIRS）, infection, postoperative complications, mortality, APACHEII score, length of hospital stay and other clinical indicators were recorded. Results On postoperative day 1, prealbumin and retinol binding protein were significantly lower as compared to preoperative levels. These parameters increased significantly （P〈0.05） on postoperative day 6 and the nitrogen balance was positive. On postoperative day 6, CRP was significantly lower in both groups as compared to postoperative day 3 （P〈0.05）, and the decrease was more prominent in Lipoplus than Lipofundin （P〈0.05）. There was a significant increase in LTB5/LTB4 as compared to postoperative day 1 （P〈0.05） in the Lipoplus group, however the increase was not statistically significant in the Lipofundin group （P〉0.05）. The incidence of postoperative infection was significantly lower in the Lipoplus group （3.1% vs. 6.3%, P〈 0.05）, as was that of SIRS （9.4% vs. 15.6%, P〈0.05）. The APACHEII score was higher in the Lipoplus group but the difference was not statistically significant （3.6±2.0 vs. 3.3±2.1, P〉0.05）. The length of hospital stay was significantly shorter in Lipoplus group [（6.4±1.1）d vs. （8.2±1.3） d, P〈0.051. Conclusion Lipoplus can improve the postoperative

关 键 词：脂肪乳剂 鱼油 胃肠道肿瘤 炎性反应 营养状况 

分 类 号：R735[医药卫生—肿瘤]