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.     

含缓释淀粉的肠内营养乳剂在高龄非糖尿病食管癌病人术后的应用

目的:探讨含缓释淀粉的肠内营养(EN)乳剂在高龄非糖尿病食管癌病人术后的应用价值.方法:选择高龄非糖尿病食管癌手术病人126例,随机分为缓释淀粉EN乳剂组(研究组,n=68)和标准EN乳剂组(对照组,n=58).两组病人术后EN均采用输注泵输注,高血糖者给予外源性胰岛素控制血糖.观察两组病人血糖变化情况、胰岛素用量以及术后并发症.结果:研究组病人的血糖波动值小和胰岛素用量少,院内感染发生率低,与对照组比较有显著性差异(P＜0.05).结论:含缓释淀粉的EN乳剂较标准EN乳剂更适合高龄非糖尿病食管癌病人术后的营养支持.     

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.     

n-9单不饱和脂肪酸减轻危重症病人的氧化应激和过度炎症反应

目的:观察含有不同脂肪酸的肠外营养(PN)对危重症病人氧化应激和炎症反应的影响。方法:将40例危重症病人随机分为试验组(n=19)和对照组(n=21)。使用等氮、等热量PN,共7 d,其中非蛋白质热量为83.68 kJ/(kg.d)、氮量0.2 g/(kg.d)。对照组病人应用中长链脂肪乳剂,试验组应用橄榄油脂肪乳剂。分别于试验开始前和第8天早晨,抽取病人静脉血检测白细胞介素-6(IL-6)、C反应蛋白(CRP)、维生素E和丙二醛水平。结果:含有橄榄油脂肪乳剂的肠外营养能CRP和IL-6降低水平,减轻丙二醛浓度。结论:橄榄油脂肪乳剂能降低危重症病人的过度炎症反应,减轻氧化应激损伤。     

肠内营养乳剂对糖尿病患者术后肠黏膜通透性及免疫功能的影响

目的评估肠内营养乳剂对糖尿病患者术后肠黏膜通透性及免疫功能的影响。方法将80例接受非肠道手术治疗的糖尿病患者随机分为肠内营养组（n=40）和对照组（n=40），分别在术后给予肠内营养乳剂和单纯肠外营养治疗，测定两组患者术前、术后第1和8天的尿乳果糖／甘露醇（L／M）值及血免疫功能指标。结果术后第1和8天，肠内营养组的L／M值均明显低于对照组和术前（P均〈0．05）；术后第8天肠内营养组的IgG明显高于对照组（P=0．02）。结论肠内营养乳剂可降低肠黏膜通透性，提高患者免疫功能。     

添加合生元早期肠内营养对高血压脑出血术后患者肠道菌群及分泌型IgA的影响

目的观察添加合生元的早期肠内营养对高血压脑出血术后患者肠道主要正常菌群、粪便分泌型IgA (SIgA)和感染性并发症的影响。方法将53例高血压脑出血术后患者随机分为早期肠内营养组（对照组,n=26）和添加合生元的早期肠内营养组（研究组,n=27）,对照组于术后24～48 h采用肠内营养制剂（瑞素）开始营养支持;研究组在对照组的基础上,在肠内营养支持前14 d添加合生元制剂（金双歧）。在营养支持前和第4、8、15天分别采集粪便标本,进行肠道主要正常菌群定量分析,采用酶联免疫吸附法测定粪便SIgA。比较研究期间两组患者感染性并发症的差异。结果在肠内营养支持第8 天和第15 天,研究组大肠杆菌(P=0.004,P=0.004)和肠球菌(P=0.032,P=0.048)低于对照组,双歧杆菌(P=0.046,P=0.024)高于对照组;研究期间乳酸杆菌、类杆菌和梭菌组间比较差异均无统计学意义(P均＞0.05)。在肠内营养支持第15 天,研究组粪便SIgA高于对照组(P=0.035 )。研究组感染率低于对照组(33.33%与46.15%),但差异无统计学意义(P=0.230)。结论与普通早期肠内营养相比,添加合生元的早期肠内营养有利于促进高血压脑出血术后患者肠道菌群失衡的改善,上调肠道局部免疫功能。     

鱼油脂肪乳剂对胃癌病人术后炎性反应的影响

目的:研究鱼油脂肪乳对胃癌病人术后炎性反应的影响. 方法:将100例全胃切除术病人随机分为研究组与对照组.研究组病人术后使用中长链脂肪乳剂+鱼油脂肪乳剂,对照组使用中长链脂肪乳剂,分别检测两组病人手术前和术后第7天外周血清C反应蛋白(CRP),白细胞介素(IL-1β,IL-6)水平,并记录全身性炎症反应综合征(SIRS)的发生率. 结果:两组病人术前CRP、IL-1β和IL-6无显著性差异(P＞0.05).术后第7天各项指标与术前比均有显著性差异(P＜0.05).研究组术后SIRS发生率显著低于对照组(P＜0.05). 结论:使用添加鱼油脂肪乳的肠外营养能明显抑制胃癌病人术后的炎性反应.     

食管癌病人术后早期肠内营养的疗效观察

目的:探讨食管癌病人术后早期肠内营养的可行性、安全性和临床疗效.方法:将58例食管癌病人随机分为早期肠内营养(EEN,n=30)组和全肠外营养(TPN,n=28)组,两组均行营养支持8 d.所有病人在手术前1d、术后第9天分别测定营养指标、免疫指标、肝功能、体重等,并观察肠功能恢复情况、术后并发症、住院费用和住院时间等...     

食管癌术后早期肠内营养预防肺部感染的临床研究

目的研究食管癌术后早期肠内营养对预防肺部感染所起的作用.方法把食管贲门癌剖胸切除术患者随机分为治疗组(EN)和对照组(PN).EN组(n=50)采用术后第1～5天经鼻肠营养管滴饲能全力500～1 000ml/d,PN组(n=45)术后仅予静脉营养支持;两组病例均在术后第1天和第5天查血淋巴细胞计数、白蛋白、转铁蛋白、前白蛋白,观察这5 d内有否肺部感染.结果EN组术后无肺部感染病例,PN组4例;EN组术后第1天和第5天的白蛋白和淋巴细胞计数前后对比升高明显(P＜0.01),而PN组稍有升高(P＞0.05);两组患者的转铁蛋白和前白蛋白前后对比轻微升高(P＞0.05).结论食管癌术后早期肠内营养有预防肺部感染作用.     

低氮低热量肠外营养对食管癌术后营养状态、血糖和并发症的影响

目的：评价低氮低热量肠外营养对食管癌术后营养状态、血糖和术后并发症的影响。方法：2012年1月-2013年12月,将60例符合标准的食管癌患者按照1：1的比例随机分为低氮低热量组（研究组）和传统氮热量组（对照组）,每组30例,均行开胸食管癌切除胸内吻合术。术后前5 d采用全肠外营养支持治疗,研究组按热量20 kCal/（kg·d）,氮0.1 g/（kg·d）给予,对照组按热量35 kCal/（kg·d）,氮0.2 g/（kg·d）给予。术后观察并记录患者并发症的发生率。术前1d、术后第3、6天测定血浆总蛋白、白蛋白、前白蛋白,术前和术后第1、3、6天查动脉血气测PaO2、PaCO2、乳酸浓度等指标,并在输注肠外营养开始后3 h测末梢血糖。结果：术后第3天和术后第6天两组各蛋白指标均较术前有所降低,但是差异无统计学意义（P〉0.05）;研究组术后第1、3、6天的PaO2显著高对照组（P〈0.05）;研究组术后PaCO2、乳酸和末梢血糖要显著低于对照组（P〈0.05）。研究组术后心律失常、肺部感染、刀口感染和吻合口瘘的发生率比较差异无统计学意义（P〉0.05）;研究组术后总的并发症发生率显著低于对照组（P〈0.05）。结论：食管癌术后低氮低热量肠外营养与传统氮热量相比营养状态相似,但能更好控制术后血糖水平,有利于降低肺损伤及降低总的并发症发生率。     

Effects of a medium-chain triacylglycerol/long-chain triacylglycerol fat emulsion containing a reduced ratio of phospholipid to triacylglycerol in pediatric surgical patients

OBJECTIVE: Medium-chain triacylglycerol (MCT) has been shown to provide better nutritional support than long-chain triacylglycerol (LCT). We compared the efficacy of MCT/LCT fat emulsions containing a usual (0.12) or a decreased (0.06) ratio of phospholipid to triacylglycerol (PL:TG) in pediatric patients under surgical stress. METHODS: Three patient groups (n=10 in each) received equivalent amounts of glucose (12 g.kg(-1).d(-1)) and amino acids (2 g.kg(-1).d(-1)), but group A received a 10% MCT fat emulsion (PL:TG 0.06), group B received a 20% MCT fat emulsion (PL:TG 0.06), and group C received a 10% MCT/LCT fat emulsion (PL:TG 0.12) in amounts of 1.5 g.kg(-1).d(-1) in a randomized study. Total parenteral nutrition was given for 7 d. Blood samples were collected before total parenteral nutrition administration and on days 4 and 7 for determination of various biochemical indexes. RESULTS: Serum phospholipid concentrations were significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). Serum triacylglycerol and cholesterol concentrations and the very-low-density lipoprotein percentage were also significantly higher in group C than in group A or B on days 4 and 7 (P<0.05). The high-density lipoprotein percentage was significantly higher in group B on days 4 and 7 (P<0.05). CONCLUSIONS: In pediatric patients under surgical stress, a total parenteral nutrition regimen containing an MCT/LCT fat emulsion with a decreased PL:TG ratio (0.06) is likely to result in partly better lipid and lipoprotein metabolism than an emulsion containing the usual ratio (0.12).     

Clinical and metabolic effects of two lipid emulsions on the parenteral nutrition of septic patients

OBJECTIVE: We compared the metabolic and clinical effects of two lipid emulsions, long-chain triacylglycerols (LCT) and a mixture of medium- and long-chain triacylglycerols (MCT/LCT), in septic patients. METHODS: Both groups received total parenteral nutrition (TPN) with a solution enriched with branched-chain amino acids (BCAA). Seventy-two septic patients received TPN with MCT/LCT (group 1) or LCT (group 2). Before starting TPN (basal) and 10 d after (final), various parameters were evaluated. RESULTS: Twenty-six subjects in each group completed the study. Both groups showed an increase in cholestasis enzymes, with no significant changes in lipid parameters. The rise of retinol-binding protein and the recovery of nitrogen balance were significantly greater in group 1. A multivariate analysis of nutritional markers and catabolic parameters showed a better evolution in group 1 (P = 0.002). The MCT/LCT group exhibited a significant increase of insulin levels. Overall mortality and length of stay in the intensive care unit were not affected by the lipid emulsion. CONCLUSIONS: In septic patients who received TPN with a solution enriched with BCAAs, the use of an emulsion containing MCT provided them with a greater recovery of their nutrition status than the traditional LCT formula, without influencing the outcome.     

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.     

A metabolic comparison of a pure long-chain triglyceride lipid emulsion (LCT) and various medium-chain triglyceride (MCT)-LCT combination emulsions in dogs

Two 20% lipid emulsions containing mixtures of long-(LCT) and medium-chain triglycerides (MCT) were compared with a 20% LCT lipid emulsion. Beagles were infused with emulsions containing either 100% LCT, 75% LCT-25% MCT, or 50% LCT-50% MCT. The emulsions were part of a total parenteral nutrition (TPN) regimen that included 10% dextrose and 5.5% amino acids. Basic nutritional parameters as well as elimination kinetics were monitored. Plasma linoleic acid, ketone, lactate, pyruvate, insulin, glucose, and carnitine were analyzed. The 75% LCT-25% MCT emulsion offers little advantage over 100% LCT as a metabolic substrate. The 50% LCT-50% MCT combination proved to be a potentially better caloric source due to rapid elimination kinetics, increased ketone production, lack of deposition, and no interference with linoleic acid metabolism.     

Effects of intravenous supplementation with alpha-tocopherol in patients receiving total parenteral nutrition containing medium- and long-chain triglycerides

OBJECTIVE: To compare the effects of a lipid emulsion containing medium-chain triglycerides (MCT) and supplemented with alpha-tocopherol to a conventional long-chain triglyceride (LCT) emulsion. DESIGN: Randomised double blind study. SETTING: Department of Internal Medicine, Antwerp University Hospital. SUBJECTS AND INTERVENTIONS: Twenty-four patients with an indication for total parenteral nutrition for a minimum of 10 days were randomly assigned to two groups: group E received as lipid source MCT/LCT (50/50) suplemented with 100 mg DL-alpha-tocopherol/day and group C received LCT. Blood samples were analysed at inclusion, after 4-6 and after 9-11 days. RESULTS: In group E, serum alpha-tocopherol doubled from 11.4+/-6.9 at inclusion to 20.9+/-7.9 and to 23.8+/-8.8 microg/ml after 4 and 9 days, respectively, but did not change in group C (P=0.008). Production of thiobarbituric acid-reacting substances (TBARS) after 120 min incubation with copper decreased from 66+/-34 at inclusion to 29+/-25 nmol MDA/mg LDL and VLDL-cholesterol after 4 and to 42+/-17 after 9 days (P=0.022 when compared to group C, which underwent no significant changes). Velocity of production of fluorescent products decreased in group E but not in group C (P=0.026). CONCLUSIONS: Supplementation of TPN containing MCT/LCT with 100 mg DL-alpha-tocopherol/day leads to a doubling in serum alpha-tocopherol and to a decrease in the susceptibility of LDL and VLDL to peroxidation in vitro. SPONSORSHIP: This study was partly financed by B Braun Medical NVSA, Diegem, Belgium.     

Lipid infusion with different triglyceride cores (long-chain vs medium-chain/long-chain triglycerides): effect on plasma lipids and bilirubin binding in premature infants.

The possible beneficial effects of infusing a lipid emulsion containing 50% by weight of medium-chain triglycerides (MCT) compared with a standard long-chain triglyceride (LCT) emulsion were studied in 18 premature neonates (gestational age less than 34 weeks) requiring parenteral nutrition. The infants were assigned in a double-blind manner to receive one of the two lipid emulsions over 17 hours a day as a supplemental regimen for total parenteral nutrition. A lipid load of 1 g/kg per day was initiated on the third day of life and was increased at the rate of 1 g/kg per day until a maximal dose of 3 g/kg per day was obtained on the fifth day of life and maintained thereafter. Both bound and unbound bilirubin decreased with both infusion regimens during the study period. Despite a marked increase in plasma free fatty acid levels (260% in the MCT/LCT group compared with 210% in the LCT group), the fraction of unbound (free) bilirubin was significantly lower in the MCT/LCT group (34% vs 13%). Free fatty acid levels, corrected to albumin, were positively correlated to the percentage of free bilirubin only for the LCT lipid infusion. The finding of a significant elevation of plasma cholesterol levels only in the MCT/LCT group is now under investigation. Use of the MCT-containing emulsion was not associated with a higher frequency of adverse effects than the commonly used LCT-containing emulsion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medium chain triglycerides in septic patients on total parenteral nutrition

The object of this study was to compare the metabolic effects of a 10% long chain triglyceride (LCT) emulsion with those produced by a 10% emulsion of medium and long chain triglycerides, MCT/LCT. During 7 days, 20 septic patients received total parenteral nutrition. Daily between 9:00 and 21:00 hours, 0.14 ± 0.01 triglycerides/kg body weight/h was infused. Nine received an LCT emulsion, 11 an MCT/LCT emulsion. Venous blood samples were taken on each of the 7 days at 09:00 and 17:00 hours. No signs of complications attributable to the lipid infusion were observed. The plasma concentrations of phospholipids, triglycerides, free glycerol, non-esterified fatty acids, and sometimes cholesterol, rose during the lipid infusion. Blood ketone body levels did not increase. With both emulsions a day by day acumulation of phospholipids (at09:00 and 17:00 hours) in the plasma was observed. Cholesterol also accumulated but only with the LCT emulsion. The nitrogen balance and urinary excretion of creatinine and of 3-methylhistidine/creatinine ratio was lower with the MCT/LCT emulsion, which suggests less muscular catabolism in patients receiving that emulsion.     

Effects of medium-chain and long-chain triacylglycerols in pediatric surgical patients

Medium-chain triacylglycerols (MCTs) have been shown to provide better nutritional support than long-chain triacylglycerols (LCTs). This study compares the efficacy of MCT combined with LCT with LCT alone in pediatric patients with surgical stress. Two groups of patients (n = 19 in each) received equivalent amounts of glucose (12 g. kg. d) and amino acids (2 g. kg. d), but one group received 10% Lipofundin MCT/LCT and the other received 10% LCT (1.5 g. kg. d) in a randomized study. Total parenteral nutrition (TPN) was given for 14 d. Blood and urine samples were collected before and after TPN administration for determination of various biochemical parameters. Indirect calorimetry was also performed to determine respiratory quotients and fuel utilization. After 14 d of TPN in the MCT/LCT group, there was a significantly higher blood lymphocyte percentage, a decreasing tendency of serum asparate aminotransferase and of total and direct bilirubin (P < 0.05). These changes were not observed in the LCT group. A significantly better nitrogen balance and a higher ketogenesis from day 3 were observed in the MCT/LCT group. The MCT/LCT group showed a more marked increased utilization of fat than the LCT group, whereas carbohydrate oxidation was less in the MCT/LCT group than in the LCT group (P < 0.05). In children after surgery, MCT/LCT is more protein sparing and induces a better immune response when compared with LCT-containing lipid emulsion. A TPN regimen containing MCT/LCT is likely to result in rapid oxidation of fats for energy without compromising the respiratory system.     

Effects of parenteral structured lipid emulsion on modulating the inflammatory response in rats undergoing a total gastrectomy

OBJECTIVES: Structured lipid emulsion improves the nitrogen balance and is rapidly cleared from the blood of moderately catabolic patients. However, the effects of structured lipids on inflammatory reactions during major surgery are not clear. This study investigated the effect of a parenteral structured triacylglycerol emulsion on leukocyte adhesion molecule expression and inflammatory mediator production in rats undergoing a total gastrectomy. METHODS: Normal rats with internal jugular catheters were assigned to three experimental groups and received total parenteral nutrition. At the same time, a total gastrectomy was performed on the experimental groups. The total parenteral nutrition solutions were isonitrogenous and identical in nutrient compositions except for differences in the composition of the fat emulsion. Group 1 received a conventional fat emulsion with long-chain triacylglycerols (LCTs), group 2 received a physical mixture of medium-chain triacylglycerols (MCTs) and LCTs (MCT/LCT), and group 3 received structured lipids composed of MCTs and LCTs (STG). Half of the rats in each respective group were sacrificed 1 d and the other half 3 d after surgery to examine the analytical parameters. RESULTS: Plasma cholesterol and free fatty acid levels in the STG group were lower than those in the other groups after surgery. The STG group had lower leukocyte CD11a/CD18 expressions than the MCT/LCT group 3 d after surgery, and CD11b/CD18 expressions in the STG group were lower than those in the LCT group on postoperative days. The STG group had higher monocyte chemotactic protein-1 and macrophage inflammatory protein-2 levels in peritoneal lavage fluid than did the other two groups. CONCLUSION: These results suggest that, compared with the LCT and MCT/LCT groups, rats administered STG had lower plasma lipid concentrations and leukocyte integrin expressions. In addition, STG administration may cause increased recruiting of neutrophils and monocytes at the site of injury and enhance antipathogenicity in rats undergoing a total gastrectomy.