脂肪乳

背景脂肪乳是肠外营养时机体的能量来源之一。除供能外,脂肪乳尚可提供必需脂肪酸。20世纪60年代开始在临床上应用,近50年来,脂肪乳从最初的长链脂肪乳到最近的鱼油脂肪乳,已经有多种类型的制剂在国内使用。证据20世纪90年代前,对肠外营养中是否必须包含脂肪乳,存在一定争议。2     

早产儿非脂肪乳静脉营养治疗的临床观察

【目的】探讨非脂肪乳静脉营养能否满足早产儿早期生长发育的能量需要,以及了解静脉营养临床应用的常见并发症。【方法】分别测量3组不同营养方法支持的94例早产儿2周时的体重,并观察住院期间各组患儿腹泻、消化道出血发生率及转氨酶、胆红素升高情况。【结果】非脂肪乳静脉营养组与脂肪乳静脉营养组早产儿体重增长无差异(P>0.05),非脂肪乳静脉营养组与葡萄糖治疗组比较差异有显著性(P<0.05);非脂肪乳静脉营养组与脂肪乳静脉营养组转氨酶及胆红素增高情况比较差异有显著性(P<0.05),非脂肪乳静脉营养组与葡萄糖治疗组腹泻及消化道出血发生率比较差异有显著性(P<0.05)。【结论】非脂肪乳静脉营养能够满足早期早产儿生长发育的能量需要,并能减少常见消化系统并发症的发生。     

外周静脉营养支持在危重早产儿的应用

本文报告了外周静脉营养支持在危重早产儿的应用，重点观察了营养支持对营养和代谢的影响，７０例早产儿分成两组，３５例为营养支持组，另３５例为对照组，结果显示，１０天的营养支持能够维持体重及血浆白蛋白，增加血清纤维连接蛋白，减少负氮平衡和尿中３－甲基组氨酸排出量。对营养支持组血清胆红素和碱性磷酸酶升高的可能原因进行了讨论，褥地危重早产儿的治疗具有十分重要的临床意义。     

早产儿静脉输注脂肪乳外渗的护理

目的探讨早产儿静脉输注脂肪乳外渗时安全、高效、舒适的护理方法。方法将40例静脉输注脂肪乳外渗的早产儿按发生外渗先后顺序随机分为实验组和对照组各20例,两组均给予输液脂肪乳外渗常规处理,实验组在此基础上外涂喜辽妥,对照组予50%硫酸镁湿热敷,比较两种护理方法在早产儿静脉输注脂肪乳外渗后疼痛缓解、肿胀消退时间及治愈效果。结果两组局部皮肤损伤程度差异无统计学意义;实验组局部疼痛缓解及肿胀消退时间较对照组明显缩短,局部皮肤损伤治疗有效率达100%,明显高于对照组有效率70%,两组间差异具有统计学意义(p<0.05)。结论早产儿输注脂肪乳外渗时在常规处理基础上外涂喜辽妥的护理方法安全、高效,患儿舒适,临床效果显著。     

左旋肉毒碱的代谢与营养效应

Carnitine is a water solule quaternary ammonium compound,which isa natural constituent of higher organisms,in particular of cells of animal origin.In humans,carnitine is synthesized in liver,brain and kidney starting from protein-bound lysine and methionine.Skeletal and heart muscle cannot synthesize carnitine.Therefore,these tissues are entirely dependent on carnitine uptake from the blood.In tissues and in physiological fluids carnitine is present in a free and an esterified form.The proportion of esterified carnitine may vary considerably with nutritional conditions,exercise and disease states.Tissue carnitine content depends on many factors: dietary carnitine,lysine,methionine and co-factor intake,carnitine synthesis (in uremia carnitine synthesis in the kidney is obviously reduced or absent),carnitine transport inside and outside tissues,and carnitine excretion.The transport of long-chain fatty acid esters to sites of beta-oxidation in the mitochondrial matrix requires L-carnitine.Besides,carnitine acts as a sink and allows a shift of the acyl pressure from the mitochondria to the cytoplasm.It has been suggested that carnitine is also important for the transport of the acyl groups (metabolic energy)from one cell to another cell and into the appropriate cellular compartment.Tissue carnitine content is much higher htan tissue CoA content and so acylcarnitines may also serve as storage for metabolic energy.By modulating the tissue content of acyl-CoA compounds which inhibit many enzyme activities (e.g.pyruvate dehydrogenase activity),carnitine may regulate many metabolic pathways.Carnitine system is located in the crossroads of intermediate metabolism and carnitine deficiency and supplementation may affect lipid,glucose and protein metabolism (and eventually nutrition) not only in primary,but also in secondary carnitine deficiency.Some positive effects of carnitine supplementation have been reported in experimental studies,in newborns,in patients treated with artificial nutrition (e.g. in acutely ill patients,in which carnitine excretion may be elevated),and in several disease states.It may be difficult to identify carnitine depleted patients which could benefit from carnitine Suplementation,because serum carnitine levels may be unrelated to tissue carnitine content.Therefore,a trial of L-carnitine may be considered,when insufficient intake or increased requirements are suspected.     

早产儿早期静脉营养临床效果观察

目的:探讨早期静脉营养对早产儿的临床效果。方法:对122例不能完全耐受肠道营养的早产儿随机分成观察组(62例)和对照组(60例)。观察组在生后48 h内使用输液泵持续24 h均匀静脉输入营养液;对照组生后第3天给予同样静脉营养治疗。同时,两组患儿均根据病情尽早经口微量喂养。两组均每天测量体重及微量血糖。结果:观察组患儿生理性体重下降期持续时间短(P(0.01);两组患儿生后相同日龄测得FFA、TBiL、DBiL、TG、Chol无显著差异(P(0.05);观察组患儿并发症发生率低(P(0.05)。结论:早产儿对早期静脉营养能够耐受,并可缩短生理性体重下降期、促进生长发育、降低并发症的发生。     

早期微量喂养联合静脉营养在早产儿营养支持中的应用

目的探讨早期微量喂养联合静脉营养对早产儿营养支持的作用。方法选取2014年6月-2015年5月该院儿科收治的早产儿89例作为研究对象,随机分为观察组(46例)和对照组(43例),两组患儿均给予外周静脉营养治疗,且观察组在给予外周静脉营养治疗的基础上再给予早期微量肠内喂养治疗。比较两组患儿住院时间、黄疸消退时间、足量喂养所需时间、体质量平均增加情况,检测血糖、尿素氮、血清前白蛋白、总胆红素等血清学指标,并比较并发症情况。结果治疗期间,观察组患儿住院时间、黄疸消退时间、足量喂养所需时间均明显低于对照组(均P0.001);体质量增加量明显高于对照组(P0.05);治疗后,观察组患儿血糖、尿素氮、血清前白蛋白、总胆红素水平均明显高于对照组,并明显高于治疗前(均P0.001);治疗期间观察组患儿并发症发生率明显低于对照组(P0.05)。结论早期微量喂养联合静脉营养对早产儿营养支持既能保证早产儿的能量、营养需求,又有锻炼早产儿胃肠功能,效果显著。     

危重早产儿部分静脉营养支持疗法应用探讨

我科自2002年1月-2004年1月规范应用部分静脉营养(PPN)支持疗法治疗41例危重早产儿,取得了满意疗效,现报告如下。     

PVC静脉营养袋DEHP溶出量及其风险评估

分别以上市的静脉营养液和脂肪乳作为浸提介质,探索由DEHP增塑的PVC材料制成的一次性使用静脉营养输液袋在临床极限使用条件下DEHP的溶出量,为风险评估提供依据。     

鱼油脂肪乳在肝胆管恶性肿瘤术后病人肠外营养中的价值

目的: 研究添加鱼油脂肪乳对肝胆管恶性肿瘤术后病人肝功能恢复和营养状况的评价. 方法: 肝胆管恶性肿瘤切除术后病人32例,随机分为对照组和研究组,两组病人均接受等氮、等热量PN支持,研究组加用鱼油脂肪乳.比较手术前后两组病人血清蛋白质、血糖、胆红素、转氨酶和碱性磷酸酶水平和感染并发症的发生率. 结果: 经术后连续7 d的治疗,研究组病人血清蛋白质和胆红素水平明显改善,与对照组比有显著性差异(P<0.05),感染并发症亦明显少于对照组. 结论: 肝胆管恶性肿瘤术后病人应用鱼油脂肪乳,有利于营养状况和肝功能的恢复.     

Essential Fatty Acid Requirements and Intravenous Lipid Emulsions

Linoleic acid (LA) and α‐linolenic acid (ALA) must be supplied to the human body and are therefore considered essential fatty acids. This narrative review discusses the signs, symptoms, diagnosis, prevention, and treatment of essential fatty acid deficiency (EFAD). EFAD may occur in patients with conditions that severely limit the intake, digestion, absorption, and/or metabolism of fat. EFAD may be prevented in patients requiring parenteral nutrition by inclusion of an intravenous lipid emulsion (ILE) as a source of LA and ALA. Early ILEs consisted solely of soybean oil (SO), a good source of LA and ALA, but being rich in LA may promote the production of proinflammatory fatty acids. Subsequent ILE formulations replaced part of the SO with other fat sources to decrease the amount of proinflammatory fatty acids. Although rare, EFAD is diagnosed by an elevated triene:tetraene (T:T) ratio, which reflects increased metabolism of oleic acid to Mead acid in the absence of adequate LA and ALA. Assays for measuring fatty acids have improved over the years, and therefore it is necessary to take into account the particular assay used and its reference range when determining if the T:T ratio indicates EFAD. In patients with a high degree of suspicion for EFAD, obtaining a fatty acid profile may provide additional useful information for making a diagnosis of EFAD. In patients receiving an ILE, the T:T ratio and fatty acid profile should be interpreted in light of the fatty acid composition of the ILE to ensure accurate diagnosis of EFAD.     

高剂量二代脂肪乳对早产儿体格发育的有效性及安全性

目的分析高剂量二代脂肪乳对早产儿血生化指标、体格增长和相关并发症的影响。方法选取2019年1月至12月于温州医科大学附属第六医院分娩的92例早产儿为研究对象,随机分为对照组和观察组各46例。对照组出生24h内开始给予200g/L脂肪乳剂0.5g·kg^-1·d^-1,每日增加0.5g·kg^-1·d^-1,直至3.5g·kg^-1·d^-1;观察组出生24h内给予200g/L脂肪乳剂2.0g·kg^-1·d^-1,每日增加0.5~1.0g·kg^-1·d^-1,直至3.5g·kg^-1·d^-1。比较两组基本情况、体格增长、血生化指标和相关临床指标情况。结果两组性别、胎龄、分娩方式、出生体质量及出生1min Apgar评分比较差异均无统计学意义(均P>0.05);两组出生时身长、头围、胸围、臂围及出生4周时身长、头围、臂围的比较,差异均无统计学意义(均P>0.05),观察组出生4周胸围明显大于对照组,差异有统计学意义(t=5.42,P<0.05);观察组第7d时静脉输入葡萄糖速度快于对照组,出生2周时血甘油三酯(TG)含量明显低于对照组(t值分别为2.45、5.64,均P<0.05);观察组静脉营养持续时间和住院天数均明显缩短(t值分别为7.03、4.71,均P<0.05),且低T3综合征和胃肠外营养相关性胆汁淤积(PNAC)发生率较对照组均明显降低(均P<0.05)。结论早产儿出生24h内可耐受静脉滴注高剂量(初始2.0g·kg^-1·d^-1)二代脂肪乳,通过合理的胃肠外营养支持可改善早产儿体格生长和发育,减少静脉营养持续时间和住院天数,同时可有效降低PNAC和低T3综合征的发生率,具有较高的安全性,值得临床应用。     

Histopathological findings in uremic rats and the effect of total parenteral nutrition with a fat emulsion

The present study describes morphological changes in rats with severe experimental uremia and the effects of different nutritional treatments. The influence of an intravenously administered fat emulsion was given special attention. After 10 days on a laboratory stock diet the uremic rats and shamoperated controls were given low nitrogen total parenteral nutrition or oral diets with low or high protein content for 10 days. The kidney remnant showed marked hypertrophy and histopathological changes were found mainly in the tubuli. Fat deposition in glomeruli and tubuli was noted in all uremic rats irrespective of dietary regimen. Both uremic and sham-operated rats on parenteral nutrition showed increased spleen weights and slight deposition of fat pigments in the reticuloendothelial cells. Relative heart weight was significantly elevated in uremic rats. It is concluded that administration of a fat emulsion as part of total parenteral nutrition was without negative effects in uremic rats.     

鱼油脂肪乳在重症急性胰腺炎病人中的研究进展

重症急性胰腺炎(SAP)的患病率呈逐年上升,病死率高,严重威胁着病人的生命。近年来,免疫营养在SAP的治疗中成为研究热点,其中免疫营养中的鱼油脂肪乳作为一种新型的脂肪乳剂,既能为机体提供营养、调节代谢,又能抑制炎性反应、降低氧化应激、调节免疫和信号转导、保护各重要器官,能有效地抑制全身性炎症反应综合征(SIRS)向多器官功能障碍综合征(MODS)发展,改善病人的预后。     

不同剂量脂肪乳剂对危重早产儿血气的影响

目的：观察脂肪乳剂对危重早产儿动脉血气的影响。方法：将４０例患有肺炎等疾病的危重早产儿随机分成四组,其中１组不给予脂肪乳剂作为对照,另３组分别按每天每千克体重给予１０％Ｉｎｔｒａｌｉｐｉｄ１、２和３ｇ,连续５天。在实验前和结束时分别作血脂测定和动脉血气分析。结果：动脉血气分析示各组实验后与实验前比较无显著差异,应用脂肪乳剂１．０、２．０、３．０ｇ／（ｋｇ·ｄ）后各实验组与对照组比较差异亦不显著,仅在３．０ｇ／（ｋｇ·ｄ）组显示ＰａＯ２和ＳａＯ２有下降的趋势。血脂分析示仅在实验后３．０ｇ／（ｋｇ·ｄ）组总胆固醇比实验前显著增高,甘油三酯显著高于对照组。结论：在危重早产儿应用脂肪乳剂１～３ｇ／（ｋｇ·ｄ）对血气无显著影响,但仍提出在危重早产儿应用脂肪乳剂时仍应注意监测肺功能有关指标,如动脉血气分析。     

脂肪乳剂在重症急性胰腺炎营养治疗中的安全性及有效性分析

目的 :探讨脂肪乳剂应用于重症急性胰腺炎的安全性和有效性。　方法 :回顾分析重症急性胰腺炎病人肠外营养治疗期间 ,应用脂肪乳剂的影响。 74例重症急性胰腺炎病人行肠外营养治疗 ,按静脉营养液是否含脂肪乳剂分为脂乳组和非脂乳组。　结果 :脂乳组肠外营养治疗后清蛋白、前白蛋白改善显著 (P <0 .0 1 ) ,非脂乳组则无显著变化 (P >0 .0 5 ) ,脂乳组较非脂乳组改善明显 (P <0 .0 1 ) ;血清肌酐、尿素氮等在脂乳组治疗后下降明显 (P <0 .0 5 ) ,较非脂乳组改善显著 (P <0 .0 5 ) ;营养治疗结束后 ,脂乳组高血糖症状明显得到控制 (P <0 .0 1 ) ,而非脂乳组效果不佳 (P >0 .0 5 ) ,脂乳组优于非脂乳组 (P <0 .0 5 ) ;血淀粉酶均有下降 ,脂乳组未见异常增高。　结论 :重症急性胰腺炎病人输注脂肪乳剂安全有效 ,有助于恢复正氮平衡     

Higher Doses of Fish Oil–Based Lipid Emulsions Used to Treat Inadequate Weight Gain and Rising Triene:Tetraene Ratio in a Severely Malnourished Infant With Intestinal Failure–Associated Liver Disease

Fish oil–based lipid emulsions (FOLEs) have been used to treat cholestasis in children with intestinal failure–associated liver disease (IFALD). When FOLEs are dosed at 1 g/kg/d, essential fatty acid (EFA) deficiency typically does not occur. We describe the clinical course of a severely malnourished parenteral nutrition–dependent infant with IFALD. Baseline EFA panels were normal upon starting FOLE at 1 g/kg/d. Despite biochemical improvement in IFALD, weight velocity was below target and biochemical EFA status worsened, even after correction for other factors affecting weight. The FOLE dose was increased to 1.5 g/kg/d, resulting in improvement of weight velocity and EFA status. This suggests that in severely malnourished infants being treated for IFALD, higher doses of FOLE may be required for adequate growth and to prevent EFA deficiency.     

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。     

脂肪乳剂中鱼油应用的价值

在PN中,脂肪乳剂的作用逐渐受到广泛的重视.鱼油有抑制机体炎性反应、改善肠道黏膜屏障和保护肝功能的作用.围手术期使用鱼油不仅可减少术后并发症,而且还可缩短ICU住院天数和总住院时间.     

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.