含橄榄油脂肪乳剂在食管癌患者术后肠外营养中的应用

目的 研究含橄榄油脂肪乳剂在食管癌术后肠外营养支持中应用的安全性和有效性.方法 60例胸段食管癌根治术患者用SPSS软件产生的随机数字分为对照组(n=30)和研究组(n=30),两组患者术后进行7～10 d的肠外营养支持,采用等氮、等热量、等渗透压、等液体量配方.研究组使用含橄榄油脂肪乳剂,对照组使用中/长链脂肪乳剂.所有患者分别于术前及术后第1天、第8天清晨空腹抽取外周静脉血送检.观测指标:术前营养状态及营养风险评估,包括体重、体重指数、营养风险筛查等;安全性指标,包括血常规、血电解质、谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素、结合胆红素、尿素氮(BUN)、肌酐、血糖等;有效性指标,包括血红蛋白、白蛋白、总蛋白等.结果 两组术后第8天的白蛋白及总蛋白值均在正常范围内,但研究组的测量值较对照组高(P=0.000),且研究组术后第8天与第1天的总蛋白差值较对照组高(P=0.002).术后第8天对照组的AST及BUN值升高,而研究组的AST及BUN均在正常范围且明显低于对照组(P=0.025,P=0.013).两组间在生命体征变化、不良事件发生率、血常规、血电解质、血糖、血脂等方面差异无统计学意义(P均>0.05).结论 含橄榄油脂肪乳剂在食管癌术后肠外营养支持中的应用是安全有效的;相对于中/长链脂肪乳剂而言,其对AST及BUN的影响较小.

Abstract：

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy.Methods In the randomized controlled trial,60 patients undergoing esophagectomy were divided into study group(n=30,received olive oil-based lipid emulsion)and control group [n=30,received medium-chain triglyceride/long-chain triglyceride(MCT/LCT)emulsion].The parenteral nutrition Was provided for 7-10 postoperative days.The nutritional formulas were equivalent in nitrogen,calorie,osmotic pressure,and fluid volume.Peripheral venous blood tests were performed before operation and on the first and eighth postoperative days.All the patients were evaluated by nutritional status(weight,body mass index,nutritional risk screening,etc.),safety profiles[full blood test,electrolytes,aspartate aminotransferase(AST),alanine amiotransferase(ALT),total bilirubin and direct bilirubin,blood urea nitrogen(BUN),creatinine,blood glucose,etc.],and efficacy indicators(hemoglobin,albumin,total protein,etc.).Results The albumin and total protein levels returned to the normal ranges in beth groups 8 days after operation,although both levels were significantly higher in study group(P=0.000).Also,the difference of total protein levels between the eighth and first postoperative days Was significantly higher in the study group(P=0.002).In addition,the AST and BUN readings returned to normal ranges 8 days after operation in the study group, which were significantly lower than those in control group (P = 0.025, P = 0.013).No serious adverse events were reported in both groups.Other nutritional parameters, renal and hepatic safety profiels, vital signs, and hematology showed no significant difference between two groups.Conclusions Olive oil-based lipid emulsion is a safe and efficient lipid emulsion for parenteral nutrition in patients undergoing esophagectomy.Compared with MCT/LCT, it has less effect on AST and BUN.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

目的 研究含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中应用的安全性和有效性.方法 31例选择性肝叶切除术后患者按入院顺序用随机数字表法分为对照组(n=16)和研究组(n=15),两组患者在术后48～72 h后接受连续6 d的等氮、等热量的肠外营养支持.研究组使用含橄榄油脂肪乳,对照组使用标准的中/长链脂肪乳.分别于术前和术后第1天、第7天取患者清晨空腹外周静脉血,检测肝功能指标和血浆蛋白水平,并观察脂肪乳的安全性和术后患者恢复情况.结果 两组患者术前总胆红素、直接胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、总蛋白、白蛋白和前白蛋白具有可比性(P均>0.05).两组患者术后的安全性及肝功能指标差异均无统计学意义(P均>0.05),但研究组术后第7天血浆总蛋白、自蛋白和前白蛋白较对照组更快恢复到正常水平,与对照组相比差异具有统计学意义[(57.57±9.84)g/L比(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L比(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L比(0.103±0.037)g/L,P=0.000],住院时间也明显缩短[(13.1±1.2)d比(15.2±1.1)d,P=0.041].研究组与对照组的并发症发生率分别为26.7%和31.3%.结论 含橄榄油脂肪乳剂具有很好的耐受性,能够促进术后血浆蛋白的恢复;可能有益于缩短术后住院时间,但对术后并发症发生率无明显影响.

Abstract：

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

含鱼油脂肪乳剂在儿童肠外营养相关性肝病的临床应用进展

肠外营养相关性肝病(PNALD)是长期肠外营养(PN)支持导致的肝损害性疾病.尽早肠道喂养替代PN是有效的防治方法,但对无法脱离PN的肠衰竭病儿,脂肪乳剂剂量及类型的选择是防治的关键之一.近年来,许多研究发现,含鱼油脂肪乳剂(FO LE)具有改善甚至逆转PNALD的作用.现对FOLE在儿童PNALD临床研究进展作一综述.     

肠外营养时脂肪乳剂的代谢及研究方法

0　引　言脂肪乳剂是肠外营养的重要组成部分 ,静脉输注脂肪乳剂除提供机体代谢所需的能量外 ,还为机体提供了生物膜和生物活性物质代谢所需的多不饱和脂肪酸 ,而且可以防止或纠正机体必需脂肪酸的缺乏。目前 ,临床上实施肠外营养时 ,人们往往注重脂肪乳剂可提供多少能量以及在能源物质中所占的比例 ,但对脂肪乳剂在循环、组织中的代谢过程以及监测脂肪乳剂代谢的方法却较少关注。1　脂肪乳剂的代谢过程脂肪乳剂是按照乳糜微粒的结构设计的 ,乳糜微粒中间是含甘油三酯、维生素Ｅ、Ｋ及胆固醇酯的核心 ,外周由磷脂及游离胆固醇构成 ,其直径在…     

脂肪乳在肠外营养中的应用进展

脂肪乳作为肠外营养支持中主要的能量来源,数十年来,已发展出多种不同配方的制剂.LCT脂肪乳由于代谢方面的缺陷,目前在临床上已被MCT/LCT脂肪乳逐步取代.较新的配方是由结构三酰甘油或橄榄油构成,此种新型脂肪乳更为安全,耐受性更好.含鱼油 ( n-3脂肪酸)的脂肪乳,可改善不同病人危重情况下的组织灌注.最新的脂肪乳SMOF,由添加维生素E的大豆长链脂肪酸、中链脂肪酸、橄榄油和鱼油混合配制而成,已在一项双盲试验中获得良好的应用,其效能尚有待进一步的临床验证.     

含橄榄油的新型脂肪乳剂对危重症病人免疫功能和炎性反应的影响

目的:通过对危重症病人分别应用含有橄榄油的新型脂肪乳与传统的中/长链脂肪乳,比较两种脂肪乳剂对病人免疫功能和炎性反应的影响. 方法:将50例入住ICU行肠外营养(PN)支持7d以上的危重症病人(APACHEⅡ评分＞12分),按前瞻、随机、对照原则分为研究组和对照组,两组病人按等氮、等热量进行全胃肠外营养(TPN)支持.于TPN前1d和TPN后第7天检测血清蛋白质、免疫和炎症指标. 结果:①TPN后两组病人的血清前清蛋白、视黄醇结合蛋白、转铁蛋白明显增加,与TPN前比有显著性差异(P＜0.05).②TPN后两组病人的C-反应蛋白下降,血总淋巴细胞计数、T淋巴细胞亚群中的T辅助性淋巴细胞(CD4)、T辅助性淋巴细胞/抑制性淋巴细胞(CD4/CD8)比值升高,研究组与对照组比有显著性差异(P＜0.05). 结论:含橄榄油的新型脂肪乳剂能提高危重症病人的免疫功能和降低炎性反应.     

脂肪乳剂在极低出生体重儿早期肠外营养中的作用

目的:探讨早期肠外营养(EPN)对极低出生体重儿(VLBW)体重增长的影响和不良反应发生情况。方法:将体重1 500 g的极低体重儿随机分为治疗组(40例)和对照组(38例)。治疗组病儿出生后24 h即应用含脂肪乳的PN,并辅以少量的胃肠道喂养和非营养性吸吮。对照组应用不含脂肪乳的PN,其他同治疗组。10 d后,检测体重变化、相关生化指标和并发症情况。结果:治疗组病儿每天体重增长幅度明显高于对照组,未增加病儿患氮质血症、高胆红素和胆汁淤积等的危险性。两组病儿并发症的发生率无显著性差异(P0.05)。结论:应用脂肪乳剂EPN,能缩短病儿平均住院时间,促进体重增长。     

复合橄榄油脂肪乳剂对免疫功能和临床结局的影响

复合橄榄油脂肪乳早在90年代就在欧洲应用于临床,目前应用的复合橄榄油脂肪乳是由橄榄油和大豆油以4∶1的比例混合而成,其多不饱和脂肪酸含量低,并富含单不饱和脂肪酸。本文复习复合橄榄油脂肪乳剂对患者免疫功能和临床结局的影响。欧洲的报道显示长期应用橄榄油脂肪乳不会造成必需脂肪酸的缺乏,对免疫功能及肝功能影响较小,其维生素E的含量适中,降低了脂质的过氧化。我国的临床研究显示复合橄榄油脂肪乳剂与大豆油脂肪乳剂在临床应用中同样安全有效,但两者对患者临床结局的影响差异无显著性。国外对结局影响的报道亦较少。大样本的、长时间的随机对照研究有待今后进行。     

十二指肠营养管在食管癌术后早期营养中的应用

目的探讨食管癌术后十二指肠营养管应用的临床效果。方法选取158例食管癌患者，随机分为肠内营养组（EN，n=80）和肠外营养组（PN，n=78），监测血浆蛋白、免疫指标及氮平衡，观察有无消化道症状、胃肠功能恢复情况及并发症等指标。结果血浆蛋白变化两组差异无统计学意义，术后第7天达正氮平衡，CD；和CD4^＋／CD8^＋比值明显升高，NK细胞活性明显增强，EN组胃肠功能恢复及住院时间较PN组明显缩短，无严重并发症发生。结论食管癌术后肠内营养具有更符合生理需求、更安全、费用低、并发症少等优点。     

脂肪乳剂对老年肿瘤患者肠外营养相关肝功能损伤影响的回顾性分析

目的研究脂肪乳剂在老年肿瘤患者术后肠外营养相关肝功能损伤（PNALD）中的作用。方法回顾性分析2003年1月至2008年12月仁济医院402例老年肿瘤患者接受肠外营养后肝功能损伤的发生情况。纳入标准：年龄≥60岁;确诊为恶性肿瘤,无远处转移且接受肠外营养前肿瘤已完全切除;接受肠外营养前患者的肝肾功能正常;接受肠外营养≥7d;采用“全合一”方式配制肠外营养液,且经过中心静脉输注。排除标准：病毒性肝炎患者;接受肠外营养期间患者死亡。年龄（71．7±6．8）岁,平均接受了（10．2±5．9）（7～61）d肠外营养支持。77．4％（311／402）患者使用了脂肪乳剂,22．6％（91／402）患者输注了不含脂肪乳剂的肠外营养液。碳水化合物、脂肪和氨基酸的平均供给量分别为（1．8±0．7）、（0．9±0．4）和（0．7±0．2）g·kg^-1·d^-1平均供热量和热氮比分别为（69．8±27．2）kJ·kg^-1·d^-1和（660．4±255．4）kJ：1g氮。结果402例老年肿瘤患者PNALD的发生率为15．2％（61／402）。接受不含脂肪乳剂肠外营养支持老年患者PNALD的发生率为8．8％（8／91）,而接受脂肪乳剂老年患者PNALD的发生率为17．0％（53／311）,两者的差异无统计学意义（X^2=3．72,P〉0．05）。脂肪乳剂种类和用量对PNALD发生率无显著影响（P〉0,05）。Logistic回归分析显示,体温升高天数（P〈0．001）、丙氨酸氨基转移酶（P〈0．001）和γ-谷氨酰转移酶（P〈0．001）是PNALD发生的危险因素。结论给老年肿瘤患者术后应用脂肪乳剂是安全的,且对PNALD的发生未产生显著影响。     

鱼油脂肪乳对肠外营养大鼠小肠黏膜紧密连接形态结构的影响

目的:探讨鱼油脂肪乳剂(富含ω-3多不饱和脂肪酸)对肠外营养(PN)大鼠肠上皮细胞紧密连接(TJ)形态和紧密连接蛋白occludin表达的影响。方法:将大鼠随机分为四组,即对照组(正常喂食),PN(禁食5d行PN支持)组,小剂量鱼油治疗(1 ml/kg鱼油静脉注射+PN)组和大剂量鱼油治疗(2 ml/kg鱼油静脉注射+PN)组。观察大鼠术后小肠黏膜上皮细胞TJ形态,以及紧密连接蛋白occludin的表达分布。结果:PN组大鼠治疗5 d后肠上皮细胞TJ结构部分缺失、间隙增宽;大剂量鱼油治疗组TJ形态基本完整,小剂量鱼油治疗组TJ部分缺失。各组occludin蛋白总量无明显差异。提取脂筏组分,发现与对照组比,三个实验组脂筏区域中occludin蛋白表达均明显减少,但大剂量鱼油治疗组较PN组明显升高(P<0.01)。结论:长期PN可导致TJ结构的缺失,脂筏区域紧密连接蛋白occludin表达减少。大剂量鱼油脂肪乳剂可维持occludin蛋白在脂筏区域的表达,保护小肠黏膜细胞TJ的结构和功能。