个体化肠外营养支持对比预混肠外营养配方对急性肾损伤患者肝功能的影响  

Effects of individualized parenteral nutrition versus pre-mixed parenteral nutrition on liver function of patients with acute kidney injury

作　　者：张瑞[1] 郑军[2] 杨浩[1] 金小越[1] ZHANG Rui;ZHENG Jun;YANG Hao;JIN Xiaoyue(Dept.of Pharmacy,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China;Intensive Care Unit,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China)

机构地区：[1]新疆医科大学第六附属医院药学部,乌鲁木齐830002 [2]新疆医科大学第六附属医院重症医学科,乌鲁木齐830002

出　　处：《中国药房》2023年第4期457-460,共4页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81760749);新疆医科大学第六临床医学院(第六附属医院)2020年科研专项基金资助项目。

摘　　要：目的比较个体化肠外营养支持对比预混肠外营养配方对急性肾损伤(AKI)患者肝功能的影响。方法选择2021年1月-2022年3月我院重症医学科收治的97例AKI患者,按随机数字表法分为商业预混多腔袋(MCB)组(48例)和个体化全合-营养液(COM)组(49例)。两组患者及时给予纠正可逆性病因的常规治疗,待液体复苏成功或小剂量血管活性药物血流动力学稳定后48 h内开始肠外营养支持治疗。MCB组患者给予脂肪乳氨基酸(17)葡萄糖(11%)注射液1袋,静脉输注,每日1次。COM组患者给予中/长链脂肪乳注射液(C8~24Ve)0.5~0.8 g/kg+复方氨基酸18AA-Ⅶ1.0~1.2 g/kg+葡萄糖注射液1.5~2.5 g/kg+注射用水溶性维生素1支+脂溶性维生素注射液(Ⅱ)10 mL+多种微量元素注射液(Ⅱ)10 mL+个体化补充氯化钠、氯化钾,糖脂比5∶5、热氮比100∶1。两组患者疗程均为7 d。观察两组患者治疗前后的肝功能异常占比、肝功能指标[丙氨酸转氨酶(ALT)、总胆红素(TBIL)、天冬氨酸转氨酶(AST)]、白蛋白(ALB)、白细胞介素6(IL-6)及C反应蛋白(CRP)水平。结果治疗后,MCB组患者的肝功能异常占比、ALT、AST、CRP水平均显著高于同组治疗前,且MCB组患者的肝功能异常占比、ALT、CRP水平均显著高于COM组(P<0.05);COM组患者治疗前后肝功能异常占比、ALT、AST、TBIL、CRP水平比较,差异均无统计学意义(P>0.05)。结论个体化肠外营养支持治疗可减少AKI患者肝损伤的发生,改善患者的营养状况。OBJECTIVE To compare the effects of individualized parenteral nutrition versus pre-mixed parenteral nutrition on liver function of patients with acute kidney injury(AKI).METHODS Totally 97 AKI patients in the intensive care unit of our hospital from January 2021 to March 2022 were collected and randomly divided into pre-mixed multi-chamber bag(MCB)group(48 cases)and compounded parenteral nutrition(COM)group(49 cases).The patients in both groups were given routine treatment to correct the reversible cause in time,and parenteral nutrition support treatment was started within 48 hours after the fluid resuscitation was successful or the hemodynamics of low-dose vasoactive drugs were stable.MCB group was given one bag of Fat emulsion amino acid(17)glucose(11%)injection,intravenous infusion,once a day;COM group was given Medium/long chain Fat emulsion injection(C8-24Ve)0.5-0.8 g/kg+Compound amino acid 18AA-Ⅶ1.0-1.2 g/kg+Glucose injection 1.5-2.5 g/kg+one Water soluble vitamin injection+Fat-soluble vitamin injection(Ⅱ)10 mL+Multiple trace element injection(Ⅱ)10 mL+individualized supplement of sodium chloride and potassium chloride,with a ratio of glucose to lipid of 5∶5 and a ratio of heat to nitrogen of 100∶1.The treatment course of both groups lasted for 7 days.The percentage of abnormal liver function,the levels of liver function indexes[alanine aminotransferase(ALT),total bilirubin(TBIL),aspartate transaminase(AST)],albumin(ALB),interleukin-6(IL-6)and C-reactive protein(CRP)were observed in 2 groups before and after treatment.RESULTS After treatment,the ratio of liver dysfunction,the levels of ALT,AST and CRP in MCB group were significantly higher than before treatment;the ratio of liver dysfunction,the levels of ALT and CRP in MCB group were significantly higher than COM group(P<0.05).There were no statistical significance in the ratio of liver dysfunction,the levels of ALT,AST,TBIL and CRP in COM group before and after treatment(P>0.05).CONCLUSIONS Individualized parenteral nutrition support treatment ca

关 键 词：急性肾损伤 肝损伤 个体化肠外营养 肝功能 

分 类 号：R979.9[医药卫生—药品] R459.3[医药卫生—药学]