脂肪乳的特点及临床应用

脂肪乳剂是构成TPN中非蛋白质能量的来源之一。传统的以大豆油为基础的长链脂肪乳,由于长链脂肪乳存在导致脂质过氧化、免疫抑制、诱发炎症和损伤内皮系统作用的潜在风险,因此,研究出了中/长链脂肪乳剂、鱼油、橄榄油、结构脂肪乳剂、SMOF等。不同脂肪乳剂的差别主要在于甘油三酯的不同,即结合于甘油的脂肪酸的不同,而脂肪酸的不同代谢特点决定了各种脂肪乳剂在临床中的不同应用。     

气相色谱法研究脂肪乳剂对全胃切除患者血浆游离脂肪酸质量浓度的影响

0　引言　脂肪乳剂中含有丰富的亚油酸和亚麻酸 .亚油酸的含量占 5 4% ,亚麻酸的含量占 6 %～ 9% [1 ] .因此 ,含脂肪乳剂的全胃肠外营养支持不仅可以较少的液体容量而提供较多的非蛋白热量 ,而且还可提供必须脂肪酸和磷 .以前的研究表明 ,长期无脂全胃肠外营养和禁食患者会引起必须脂肪酸缺乏症 .但是 ,手术创伤和手术后全胃肠外营养支持对血浆脂肪酸谱的影响 ,国内尚未见报道 .我们应用气相色谱法对全胃切除患者全胃肠外营养支持期间血浆游离脂肪酸谱作了动态观察 .1　材料和方法1.1　材料　仪器和试剂 10 3型气相色谱仪 ;脂肪乳剂 ;甲醇 …     

创伤和静脉营养支持对血清脂类代谢的影响

本文通过测定胃癌根治术前后的血清总胆固醇、甘油三酯、三种脂蛋白及二种载脂蛋白的变化,以了解腹部大手术后应用静脉营养支持(IVN)对脂质代谢的影响。结果表明,胃癌根治术后脂质和脂蛋白有其特定的代谢规律,应用脂肪乳剂不增加体内脂质的负荷,IVN 支持不会扰乱术后脂质和脂蛋白的代谢模式。     

脂肪乳剂不良反应的原因分析及护理

脂肪乳剂是肠外营养药能量补充剂，营养支持对危重病人、外科手术后病人治疗很重要。脂肪乳剂具有含热量高、等渗、提供必需脂肪酸、在体内氧化无需胰岛素参与等特点。因而是肠外营养支持配方中的重要能源物质。我院ICU自2003年1月-2004年3月，由外周静脉或中心静脉滴注脂肪乳剂注射液167例，其中男96例，女71例，年龄27～89岁，平均年龄59．5岁，共发生不良反应5例。其中2例表现为皮疹、瘙痒，2例表现为胸闷、气急，1例表现为心跳呼吸骤停2次，因发现早，处理及时，均无不良后果。     

噻唑蓝还原法测脂肪乳剂对人结肠癌细胞增殖的影响

目的:测定脂肪乳剂和5-FU单独或共同培养情况下对人结肠癌细胞增殖的影响,为肿瘤患者应用脂肪乳剂作为营养支持手段提供必要的理论基础。方法:应用噻唑蓝还原法(MTT法)观察LoVo结肠癌细胞株与不同浓度脂肪乳剂和5-FU单独或共同培养情况下,脂肪乳剂和5-FU对LoVo细胞增殖的影响。结果:5-FU对LoVo细胞增殖的抑制随其浓度的增加而增加;较高浓度脂肪乳剂对LoVo细胞的增殖有促进作用;不同浓度的脂肪乳剂与5-FU联合应用并不影响5-FU对LoVo细胞的抑制作用。结论:体外实验表明,脂肪乳剂并不影响化疗药物抑制肿瘤细胞增殖的作用,化疗期间可应用脂肪乳剂提供必要的营养支持。     

鱼油甘油三酯对甘油三酯丰富颗粒的小鼠血液清除的影响

近年来含n-3甘油三酯(n-3 TG)(鱼油)的脂肪乳剂已被应用于临床病人的营养支持和疾病治疗中。迄今为止，对n-3脂肪酸(n-3 FAs)和n-3 TG的研究大多局限于因果一效应探讨，而含n-3 TG的脂肪乳剂以及TG丰富脂蛋白的清除等基础代谢尚不十分清楚。为此，我们利用小鼠模型对n-3 TG丰富颗粒(n-3 TGRP)的清除代谢进行了探讨。     

普外科危重患者术后的空肠内营养

营养支持是治疗外科危重患者的一个重要措施。尤其是严重创伤、手术或感染的患者，脂肪和肌肉的分解代谢比单纯禁食者明显加快。表现为高代谢和分解代谢，机体能量消耗增加，体内蛋白质分解加速，呈负氮平衡。合理的营养支持可减轻蛋白质消耗和营养不良，维持机体重要脏器的结构和功能，从而降低危重患者的并发症和病死率。     

代谢监测和代谢监测系统进展

重危患者有效的代谢治疗与营养支持,依赖于成功的代谢监测。代谢监测概念的提出和代谢监测系统的不断更新换代,是重症监护和营养支持进一步发展的必然结果,它又促使了重症监护特别是营养支持方法的日益成熟。本文就这一方面的发生发展,尤其是近10年的进展作一介绍。一、代谢监测与有关概念生物体内物质(主要是糖、脂肪、蛋白质)在代谢过程中所伴随的能量释放、转移和利用等,通常称为     

96岁患者术后营养治疗1例报告

营养支持是外科治疗术后患者的一个重要措施，特别是严重创伤、高龄手术或感染的患者，脂肪和肌肉的分解比单纯禁食者明显加快，表现为高代谢和分解代谢，机体能量消耗增加，体内蛋白质分解加速，呈负氮平衡。合理的营养支持可减轻蛋白质的消耗和营养不良，维持机体重要脏器的结构和功能，从而降低患者的并发症发生率和病死率。     

外科危重患者的营养支持

营养支持是治疗外科危重患者的一个重要措施。尤其是严重创伤、手术或感染的患者脂肪和肌肉的分解代谢比单纯禁食者明显加快。表现为高代谢和分解代谢，机体能量消耗增加，体内蛋白质分解加速，每人每日可消耗脂肪２５０～５００ｇ，负氮平衡达每日１５～３０ｇ［１］。这...     

TOTAL PARENTERAL NUTRITION

Total parenteral nutrition (TPN) is now ac- cepted as an important life-sustaining treatment for patients whose nutritional intake has ceased or is severely curtailed. The article covers 76 cases receiving TPN treatment by central venous catheterization and 62 cases receiving nutritional support by periDheral vein, totalling 3,674 days. The patients achieved positive nitrogen balance, weight gain and wound healing during TPN treatment, but these results could hardly be achieved by peripheral nutritional support, if fat emulsion is not supplied. The complications decreased gradually from 1971 t0 1980. It is im- portant to set up a TPN team to care for the patient receiving parenteral nutritional treat- ment.     

Changing concepts in lipid nutrition in health and disease

Fat remains a hot topic because of concerns over associations between consumption of fats and the incidence of some chronic conditions including coronary artery disease, diabetes, cancer and obesity. Dietary fats serve multiple purposes. The effects of dietary fats generally reflect the collective influences of multiple fatty acids in the diet or food. This presentation highlights some recent developments on the role of dietary fats and oils in health and disease. Debate continues over the role of dietary modification in coronary prevention by lipid lowering. The degree to which a recommended diet will result in health benefits for an individual is difficult to predict, because the outcome will depend on the influence of other factors such as a person's genetic constitution, level of physical activity and total diet composition. There can now be little doubt about the importance of genetic factors in the etiology of cardiovascular disease, diabetes, obesity and cancer. The importance of antioxidant status in the prevention of cardiovascular disease as well as many cancers is being increasingly recognised. It is now evident that not all saturated fatty acids are equally cholesterolemic. Recent accounts evaluating palm oil's effects on blood lipids and lipoproteins suggest that diets incorporating palm oil as the major dietary fat do not raise plasma total and LDL cholesterol levels to the extent expected from its fatty acid composition. Palm oil is endowed with a good mixture of natural antioxidants and together with its balanced composition of the different classes of fatty acids, makes it a safe, stable and versatile edible oil with many positive health and nutritional attributes. In recent times, adverse health concerns from the consumption of trans fatty acids arising from hydrogenation of oils and fats have been the subject of much discussion and controversy. Trans fatty acids when compared with cis fatty acids or unhydrogenated fats have been shown to lower serum HDL cholesterol, raise serum LDL cholesterol and when substituted for saturated fatty acids, increase lipoprotein Lp (a) level, an independent risk factor for the development of coronary heart disease. The idea of which foods, nutrients and supplements are "healthy" is often being amended as new scientific data is presented and then simplified for the consumers. What was once perceived as a healthy diet is often no longer considered as such and vice versa. Dietary recommendations have to change with time and the evidence available. Nutritional recommendations should encourage eating a great variety of nutrient sources within our food supply in moderation. Various lifestyle options to improve health should also be promoted.     

橄榄油脂肪乳剂的研究进展

脂肪乳剂在20世纪60年代已经在肠外营养中应用,并与葡萄糖共同提供能量。目前应用最为广泛的脂肪乳剂为大豆油,但有一种观点认为在肠外营养中仅使用大豆油脂肪乳剂可能不是最合理的。目前出现一种含橄榄油的新型脂肪乳剂,由80%的橄榄油和20%的大豆油混合而成,具有20%多不饱和脂肪酸和60%单不饱和脂肪酸,长期应用不会造成必需脂肪酸缺乏和降低脂质过氧化。该文对含橄榄油的新型脂肪乳剂在体外试验、动物实验和临床研究中的进展进行综述。     

Structured lipid emulsion as nutritional therapy for the elderly patients with severe sepsis

Background The nutritional support is one of the important therapeutic strategies for the elderly patients with severe sepsis, but there is controversial in choosing a parenteral nutrition formulation. This study was designed to compare the therapeutic effects of structured lipid emulsion, physically mixed medium, and long-chain fat emulsion in the treatment of severe sepsis in elderly patients.

Methods A total number of 64 elder patients with severe sepsis were enrolled in the study. After a week of enteral nutritional support, the patients were randomly divided into research (structured lipid emulsion as parenteral alimentation) and control groups (physically mixed medium and long-chain fat emulsion as parenteral alimentation). The alterations of plasma albumin, lipid metabolism, and blood glucose level were recorded after parenteral alimentation and were compared between the two groups.

Results The plasma levels of albumin, prealbumin, cholesterol, and triglyceride were decreased in all the patients after one week of enteral nutritional support treatment (t=7.78, P=0.000; t=10.21, P=0.000; t=7.99, P=0.000; and t=10.99, P=0.000). Further parenteral alimentation with different lipid emulsions had significant effects on the serum prealbumin and albumin (t=3.316, P=0.002; t=3.200, P=0.002), whilst had no effects on the blood glucose and triglyceride level (t=7.78, P=0.000; t=4.228, P=0.000). In addition, the two groups had a significantly different Apache II score, ventilator time, and hospital stay time (t= ?2.213, P=0.031; t=2.317, P=0.024; t=2.514, P=0.015).

Conclusions The structured lipid emulsion was safe as parenteral nutrition for elderly patients with severe sepsis. It was demonstrated to be superior to the physically mixed medium and long-chain fat emulsion with respect to the protein synthesis and prognosis.

     

ω-3鱼油脂肪乳注射液对重症急性胰腺炎病人临床安全性的观察

目的观察ω-3鱼油脂肪乳注射液对临床重症急性胰腺炎治疗的安全性。方法按照实验严格的纳入标准选择临床诊断明确的重症急性胰腺炎患30例,在传统治疗基础上应用脂肪乳剂ω-3鱼油脂肪乳注射液,全胃肠外营养（TPN）后第1、3、5天分别抽取静脉血化验血淀粉酶、血脂、蛋白、尿素氮、血细胞计数。结果TPN后第1天总蛋白、白蛋白、前白蛋白有所下降,随后逐渐升高,第5天检测各项蛋白指标都高于TPN前,治疗后血淀粉酶明显降低,甘油三酯、胆固醇和尿素氮在营养支持第1天后指标低于营养支持前,随着营养支持的继续。各项指标逐步升高,血脂和尿素氮水平在第5天再次出现降低,治疗后白细胞计数、中性粒细胞计数明显低于治疗前,随着治疗的进行淋巴细胞数量在第1、2天比营养前有所下降,随后再次升高。结论ω-3鱼油脂肪乳注射液临床应用治疗重症急性胰腺炎时是安全有效的。     

Dietary fatty acids and coronary heart disease

Epidemiological studies have confirmed a strong association between fat intake, especially saturated and trans fatty acids, plasma cholesterol levels and rate of coronary heart disease (CHD) mortality. Meanwhile it is clear, that early atherosclerosis is largely preventable by modifying nutritional behaviour and lifestyle. There is clear evidence that a diet moderate in total fat (25-35 % energy) is superior to extremes in dietary fat. Because fat is energy dense moderation in fat intake is also essential for weight control. Saturated fatty acids are very potent in increasing LDL-cholesterol concentration in plasma a dangerous risk factor for early CHD. Unsaturated fatty acids have numerous beneficial health effects. The results of prospective cohort studies fit well to the experimental experience of the antihypercholesterolemic action of Omega-6 fatty acids and the antithrombotic, vasodilatory and antiarrhythmic properties of Omega-3 fatty acids, while the optimistic rating of Omega-9 fatty acids is less supported by epidemiologic studies. The results of prospective cohort studies are confirmed by intervention trials revealing that saturated fatty acids enhance early development of CHD whereas polyunsaturated fatty acids, especially of the Omega-3 type, significantly preserve from CHD. In context with a prudent diet pattern favourable dietary fatty acid composition offers the best chance for a reduced risk of CHD.     

Efficacy of n-3 polyunsaturated fatty acid enriched enteral nutrient solution in relieving oxidative stress in patients with severe psychophysiologic disorders

It is not unusual for patients with severe motor and intellectual disabilities to present with eating and swallowing disorders, and such patients often require long term enteral nutrition. These patients tend to receive all their nutrients in the form of a single nutrient solution that is administered over a long period, and there are concerns about the impact of the composition of these nutrient formulas on patient health. Therefore, it is very important that adequate care be taken when selecting a nutrient formula for patients of this type. In the present study we administered two types of enteral nutrient solutions and examined the effect of the differences in nutrient composition on the degree of oxidative stress experienced by human patients. Subjects were 5 patients (mean age: 27.2 years; male/female ratio: 4:1) with severe motor and intellectual disabilities who were incapable of oral feeding, and who were receiving long term enteral nutrition. The subjects were administered a standard elemental diet for 2 months, and this was followed by administration of an n-3 polyunsaturated fatty acid enriched enteral nutrient solution for three months. Results showed that the n-3 polyunsaturated fatty acid enriched diet improved serum concentrations of trace elements, protein synthesis, and the balance between n-6 polyunsaturated fatty acids and n-3 polyunsaturated fatty acids, which are essential fatty acids. At the same time oxidative stress was reduced, and serum IgE levels declined significantly. Patients with severe psychophysiological disorders often suffer from repeated bouts of pneumonia due to immune system suppression, and there are reports that such patients are subject to increased allergic diathesis. The present results indicated that the in vivo membrane damage induced by oxidative stress may be closely related to the onset of these disorders. The results also suggested that in addition to attaining an adequate understanding of the effect of each of the various nutrients in enteral nutrient formulas, it will also be important to consider not only trace elements but also fatty acid composition in the nutritional management of patients with such disorders.     

Omega-3多不饱和脂肪酸对脂肪代谢调节作用研究进展

肥胖是2型糖尿病、心血管病和多种癌症的危险因素，其防治形势十分严峻。Omega-3多不饱和脂肪酸（n-3 PUFA）是一种从深海鱼类中提取出来的多不饱和脂肪酸，具有显著的抗炎和降低三酰甘油的作用，但其抗肥胖作用仍有争议。在动物模型中发现，n-3 PUFA可以有效降低脂肪含量；然而人体研究却表明n-3 PUFA可能无助于减肥，但可能会减少体质量进一步增加。n-3 PUFA可通过调节肠道菌群、调节脂质代谢、抑制食欲、缓解脂肪组织炎症和表观遗传改变等机制改善与肥胖相关的代谢变化，从而在肥胖与其相关代谢性疾病的防治中发挥重要作用。     

经腹膜吸收营养的动物实验研究

本实验对5只狗经腹腔内插管灌注葡萄糖、氨基酸、脂肪乳剂及电解质混合营养液,观察结果:灌注后12小时,营养液内葡萄糖、氨基酸及甘油三酯的吸收率分别为96.3％、95.2％及77.2％,每日灌注2次,腹膜可吸收葡萄糖23g、氨基酸16g、甘油三酯26.5g,可提供非蛋白质热量115.2kJ/kg、蛋白质1.33g/kg、水分吸收为41.7ml/kg,营养素和水分吸收量均可满足动物基础代谢需求。表明经腹膜吸收营养有望为一新的胃肠外营养支持途径。     

营养干预对于非酒精性脂肪性肝病的治疗作用

目的：观察营养干预对非酒精性脂肪性肝病（NAFLD）的治疗作用。方法：56例NAFLD患者给予为期6个月的膳食营养干预,观察干预后营养素摄入量、生化指标及人体成分的变化。结果：干预后,患者每日能量摄入量及碳水化合物供能比下降,蛋白质供能比上升,差异均有统计学意义（均P＜0.01）,脂肪供能比无明显改变;体质量指数（BMI）、腰臀比（WHR）、体脂肪（BFM）及内脏脂肪面积（VFA）显著下降（均P＜0.01）,体蛋白（P）及骨骼肌（SMM）无明显改变;空腹血糖（FBG）、甘油三酯（TG）、胆固醇及低密度脂蛋白（LDL）明显下降（均P＜0.01）,高密度脂蛋白（HDL）无明显改变。结论：合理的营养干预有助于NAFLD患者减低体质量及VFA,改善FBG及血脂谱,对NAFLD的治疗有益。