不同碳链脂肪乳剂对肝脏外科患者脂肪及肝脏能量代谢的影响

目的 观察两种不同碳链脂肪乳剂对肝脏外科患者术后脂肪及肝脏能量代谢的影响。方法 选择肝脏外科患者25例，随机分为2组；给予肠外营养，长链脂肪乳剂组（LCT组）12例，中／长链脂肪乳剂组（MCT组）13例。LCT组脂肪乳剂为20％英脱利匹特（Intralipid),MCT组为２０％为保肪宁（Lipofundin)，连续观察１周。在术前，术后１d、7d作脂肪廓清实验（IVFTT），并测定血及尿液中肉毒碱（CNT）以及动脉血酮体浓度及比率（AKBR）的变化。结果 MCT组清除率为LCT组的1倍，半衰期为LCT组的1／2；术后血CNT明显升高，尿排出减少，术后7d时，LCT组血CNT高于NCT组，尿CNT低于MCT组，P＜0．05；血AKBR术后1d明显下降，随后MCT组逐渐回升，在术后7d时，MCT组明显高于LCT组，P＜0．01。结论 MCT组体内清除迅速，对CNT依赖较小，并对肝脏能量代谢有保护作用。提示MCT乳剂可能是肝脏外科患者更为理想的脂肪能源。

Influence of Lipofundin vs Intralipid on lipid and energy metabolism of surgical cirrhotic patients

Objective　To study the influence of Lipofundin vs Intralipid on lipid energy metabolism of cirrhotic patients undergoing surgery.Methods　Twenty-five patients with liver disease were randomly assigned to two PN groups:LCT group(n=12) and MC/LCT group (n=13).Fat energy in group LCT was supplied by 20%-Intralipid,Group MCT/LCT was supplied by 20%-Lipofundin.All patients were on parenteral nutrition for 7 days.Intravenous fat tolerance test (IVFTT) was measured at pre-op,post-op d1、post-op d7.Carnitine （CNT） level in serum and urine,and AKBR were tested at the pre-op、post-op d1、d7.Results　The elimination rate of the MCT was faster than that of LCT at pre-op and post-op d7,the elimination rate of LCT at post-op d1 was faster than that of at pre-op and post-op d7.Serum CNT increased in both groups,urine CNT markedly decreasd at postoperation,but in LCT group CNT was at lower level as compared with MCT group at post-op d7,P＜0.05.AKBR was markedly decreased in both groups post-op,but at post-op d7,AKBR in MCT group was higher than in LCT group,P＜0.01.Conclusions　These results indicated that Lipofundin was an ideal energy source for the cirrhotic patients.