结构脂肪乳剂对肝脏手术后患者肝功能、氮平衡及蛋白质代谢的影响

目的 观察结构脂肪乳对肝脏术后患者肝功能、氮平衡及蛋白质代谢的影响.方法 将肝脏手术患者86例双盲、随机分为结构脂肪乳(STG)组和物理混合的中/长链脂肪乳(MCT/LCT)组.于术后第1～6天接受等氮等热量肠外营养.对比观察术后两组患者肝酶学、氮平衡、血浆蛋白质水平情况.结果在进行6 d的肠外营养以后,两组患者肝酶学指标差异无统计学意义(P>0.05),胆红素在POD+1明显升高,但STG组随后显著下降,MCT/LCT组下降速度慢于STG组(P<0.05).STG组氮平衡明显优于MCT/LCT组.POD+4 STG组蛋白质水平恢复至术前水平,而MCT/LCT组至POD+7才恢复至术前水平.结论 结构脂肪乳由于具有较好的节氮作用,能有效地改善肝脏术后患者的蛋白质代谢,将有利于这类患者术后更快地恢复.     

结构脂肪乳与中/长链脂肪乳对危重症患者肝功能和血脂的影响比较

目的：探讨结构脂肪乳及中/长链脂肪乳对危重症患者肝功能和血脂的影响。方法采用随机法将98例患者分为两组，即MCT/LCT组与STG组，两组均为49例，两组所患疾病、APACHE II评分、年龄及性别等均无显著性差异（P＞0.05），具有可比性。患者进入ICU后，立即对身体状况及病情进行评估，确定不存在肠外营养支持方面的禁忌证后采用MCT/LCT及STG进行治疗。在第1～2天静脉输注葡萄糖，第3天后开始实施肠外营养支持治疗，两组均连续治疗15d。结果采用两种不同的脂肪乳进行治疗后，两组的AST、TG及TCH、LDL-C差异有统计学意义（P＜0.05），MCT/LCT组的AST、TG、TCH及LDL-C值大于STG组。在HDL-C、DBIL、TBIL、ALP、及ALT方面，治疗前后两组的差异均不明显（P＞0.05）。结论在为危重症患者提供营养支持时，STG对血脂及肝功能各项指标的影响较小，应推广使用STG。     

两种脂肪乳对老年胃肠肿瘤患者术后营养疗效的比较

目的比较中长链脂肪乳及长链脂肪乳对老年胃肠肿瘤患者术后营养的疗效。方法29例老年胃肠肿瘤手术患者分为中长链脂肪乳组(MCT组,15例)和长链脂肪乳组(LCT组,14例),术后第2～7天共进行6d的肠外营养支持。除脂肪乳不同外,均给予等氮、等热卡的肠外营养,观察累积氮平衡、血浆蛋白、脂质代谢及与感染有关的并发症和术后住院天数等。结果术后经肠外营养MCT组获得正氮平衡,为(27.3±24.0)mg·kg-1·(6d)-1,而LCT组为(-17.5±16.2)mg·kg-1·(6d)-1。术后血浆蛋白水平均降低,LCT组前白蛋白的降幅为(-0.06±0.03)g/L,明显高于MCT组的(-0.02±0.03)g/L,差异有显著性意义(P<0.05)。两组患者的各项血脂水平手术前后变化均不明显。术后感染性并发症MCT组2例,LCT组3例。结论中长链脂肪乳对老年胃肠肿瘤患者术后的营养疗效比长链脂肪乳好。     

结构脂肪乳对胃肠道肿瘤患者术后细胞免疫功能的影响

胃肠道肿瘤患者术前大多数存在不同程度的营养不良和免疫功能低下,手术创伤进一步加重机体的代谢紊乱和免疫功能损害,因此,术后营养支持对于改善患者的营养状态和免疫功能十分重要.结构脂肪乳剂(structoglyceride,STG)在水解、氧化利用及产热作用均明显高于传统的长链脂肪乳剂(long chain triglycerides,LCT)[1],并且与中／长链脂肪乳(medium chain triglyceride/long chain triglycerides,MCT/LCT)相比,STG更有利于改善氮平衡及蛋白质的代谢,对三脂酰甘油及中链脂肪酸的代谢影响较小[2-3].我们观察STG、MCT/LCT和LCT对胃肠道肿瘤患者术后细胞免疫功能的影响.     

不同脂肪乳剂对肝脏术后患者肝肾功能的影响

目的 观察结构脂肪乳剂(STG)和物理混合的中、长链脂肪乳剂(MCT/LCT)对肝脏手术患者术后的影响.方法 将肝脏手术后患者随机分为STG组(n=64)和MCT/LCT组(n=61),术后第l天起连续5天分别给予STG或MCT/LCT进行肠外营养,在术后第1天(POD+1)和术后第3～5天(POD+3～5)及术后第8天以后(POD+8～)检测肝肾功能,并记录住院时间.结果术后STG组谷丙转氨酶(ALT)下降速率优于MCT/LCT组,在住院时间上STG比MCT/LCT缩短(P<0.05).结论 STG对肝脏术后患者肝功能的恢复要优于单纯物理混合的MCT/LCT.     

不同脂肪乳剂对肝移植大鼠脂代谢及氮平衡的影响

目的研究含不同脂肪乳剂（fatemulsion，FE）的肠外营养（parenteralnutrition，PN）对肝移植大鼠脂代谢及氮平衡影响。方法建立肝移植大鼠模型，随机分为葡萄糖组（GLU组，不使用FE）、结构脂肪乳剂组（STG组）、长链脂肪乳剂组（LCT组）、中长链脂肪乳剂组（MCT／LCT组）4组，于术后6h开始给予单糖或单糖与不同类型FE联合供能的PN，同时设立假手术对照组（SO组）。于PN后1、4、7d收集标本，检测氮平衡、血脂、肝组织脂类的变化。结果与3种脂肪乳剂组相比，GLU组7d内TG和LDL-C逐渐升高，HDL-C持续降低，7d时呈负氮平衡，7d动物死亡率为50％。7d内3种脂肪乳剂组血清TG、TC、LDL-C恢复正常水平，与SO组比较差异无统计学意义；HDL-C水平持续升高，7d内均达到正氮平衡；3种脂肪乳剂组均无PN所致死亡。4d时STG组先于LCT、MCT／LCT两组转为正氮平衡，7d内STG组氮平衡显著高于LCT、MCT／LCT两组，MCT／LCT组氮平衡高于LCT组。结论单糖PN显著影响受体脂代谢，导致大鼠死亡率增高；单糖不宜作为PN的惟一能源；而含FE的PN不会导致肝脏的脂肪沉积，对受体脂代谢没有明显影响。相反，能改善肝移植受体的氮平衡，有利于动物的长期存活，可用于肝移植后的营养支持。STG的作用优于MCT／LCT和LCT。     

含不同脂肪乳剂的肠外营养对肝移植大鼠肝脏功能的影响

目的　研究含不同脂肪乳剂的肠外营养 (TPN)对肝移植大鼠肝脏功能的影响。方法　建立肝移植大鼠模型 ,按照提供的能源不同分为单糖 (GLU )、脂肪乳剂MCT/LCT、LCT、STG 4个组 ,实验期为 7d ,记录实验期内动物死亡情况 ,于TPN后第 1、4、7d收集标本 ,检测AKBR(动脉血酮体比值 )、血ALT、AST、血TBIL。以正常和肝移植大鼠作为对照。结果　单糖组 7d动物死亡率显著高于脂肪乳剂组 (5 0 %vs0 % )。与脂肪乳组相比 ,单糖组动物 7d内血清ALT和AST水平降低缓慢、TBIL水平持续显著升高 ,AKBR水平在TPN后 1d恢复并稳定于较高水平 ,但于 7d时显著降低。在 1、4d时STG组动物血清ALT降低较MCT/LCTTPN组及LCTTPN组更为显著 ,MCT/LCTTPN组血清ALT水平低于LCTTPN组。结论　单糖TPN加重移植肝脏功能损害 ,动物死亡率增高 ,含脂肪乳的TPN能促进移植肝功能恢复。在减轻移植肝功能损害方面的优越性 ,依次为STG、MCT/LCT和LCT。     

全静脉营养时不同脂肪乳剂对淋巴细胞功能的影响

脂肪乳剂已成为全静脉营养(TPN)中的重要组成部分。但是据报道，普通的脂肪乳剂不论长期或短期使用都有抑制免疫的副作用。患严重疾病者接受含普通脂肪乳TPN治疗可能会因此而增加易感性，影响存活时间和复发率。最近的一系列体内体外研究证明，普通只含长链甘油三酯(LCT)脂肪乳通过影响白细胞介素-2(IL-2)与淋巴细胞表面受体的结合而干扰免疫反应。本文作者最近在体外试验的研究结果也显示，单纯LCT明显抑制IL-2介导的免疫反应，而MCT／LCT(中／长链脂肪乳)对IL-2介导的免疫反应几乎无影响。本文采用前瞻性体内试验方法研究不含脂肪乳、含LCT和含MCT／LCT三种TPN配方对免疫反应的影响。     

含不同脂肪乳剂的肠外营养对肝移植大鼠肝脏功能的影响

目的研究含不同脂肪乳剂的肠外营养(TPN)对肝移植大鼠肝脏功能的影响。方法建立肝移植大鼠模型，按照提供的能源不同分为单糖(GLU)、脂肪乳剂MCT／LCT、LCT、STG4个组，实验期为7d，记录实验期内动物死亡情况，于TPN后第1、4、7d收集标本，检测AKBR(动脉血酮体比值)、血ALT、AST、血TBIL。以正常和肝移植大鼠作为对照。结果单糖组7d动物死亡率显著高于脂肪乳剂组(50％vs0％)。与脂肪乳组相比，单糖组动物7d内血清ALT和AST水平降低缓慢、TBIL水平持续显著升高，AKBR水平在TPN后1d恢复并稳定于较高水平，但于7d时显著降低。在1、4d时STG组动物血清ALT降低较MCT／LCT TPN组及LCT TPN组更为显著，MCT／LCT TPN组血清ALT水平低于LCT TPN组。结论单糖TPN加重移植肝脏功能损害，动物死亡率增高，含脂肪乳的TPN能促进移植肝功能恢复。在减轻移植肝功能损害方面的优越性，依次为STG、MCT／LCT和LCT。     

中链甘油三酯对手术后接受肠外营养患者代谢的影响

目的比较长链甘油三酯(LCT)和中链甘油三酯(MCT)2种脂肪乳的代谢效应差异.方法24例胃、结肠手术患者和6例志愿者参加本研究,均有知情同意.患者随机分为2组,分别接受含50%MCT或单纯LCT的肠外营养.测定前臂动静脉血中甘油三酯的浓度差及氮平衡.结果MCT组肌肉利用脂肪乳的能力明显提高,氮平衡也有所改善,且术后体重减轻较少.在脂肪乳廓清试验中发现,血清酮体浓度MCT组[(0.063±0.004)mmol/L]明显高于LCT组[(0.039±0.002)mmol/L].氮储存的增加与酮体和胰岛素水平的增加相关.结论含50%MCT的脂肪乳用于肠外营养是安全的,可作为又一种能改善机体蛋白代谢的能量物质.     

不同脂肪乳对人中性粒细胞免疫功能的影响

目的:观察3种不同类型的脂肪乳剂[Intralipid(LCT)、Kalu(LCT/MCT)及Clin Oleic(LCT/MUFA)]在体外对人外周血中性粒细胞免疫功能的影响。方法:利用密度梯度法分离健康志愿者外周静脉血中的中性粒细胞(PMN),置于培养液中,分别加入3种脂肪乳剂,每种脂肪乳剂分对照和4种不同浓度(0.01%、0.1%、1%、10%)。利用PMN吞噬酵母菌的方法测定其吞噬功能;利用琼脂糖平板实验测定PMN的趋化功能;利用硝基蓝四氮唑(NBT)还原实验测定PMN氧呼吸爆发时氧自由基的产生情况。结果:①随着浓度的增加,LCT组和LCT/MCT组PMN的吞噬功能明显下降,而LCT/MUFA组的下降程度小于前两组;差异有统计学意义(P     

应用高甘油三酯钳闭技术研究不同脂肪乳剂的代谢

目的：采用高甘油三脂钳闭技术比较结构甘油三酯（ＳＴＧ）与长链甘油三酯（ＬＣＴ）在健康志愿者中的代谢效应，以评估结构脂肪乳剂代谢特征。方法：选择１６位健康志愿者进行前瞻性随机交叉对照研究。采用改良的高甘油三酯钳闭技术，维持血浆甘油三酯浓度在４ｍｍｏｌ／Ｌ水平达１８０分钟，比较ＳＴＧ和ＬＣＴ的代谢特征。结果：ＳＴＧ的血浆清除率较ＬＣＴ快一倍左右，ＳＴＧ组血清总游离脂肪酸、游离甘油及β－羟基丁酸盐浓度明     

A comparison of medium-chain and long-chain triglycerides in surgical patients.

Available lipid emulsions made from soybean or safflower oil are classified as long-chain triglycerides (LCT). In contrast, medium-chain triglyceride (MCT) emulsions have different physical properties and are metabolized by other biochemical pathways. To compare the differences between these two fat emulsions, the authors studied 12 surgical patients and 6 volunteers. These subjects were randomly assigned to receive parenteral nutrition with MCT or LCT emulsion. Measurement of arterial and venous concentration differences across the forearm demonstrated that muscle utilization was significantly improved with MCT administration. There was also a trend toward improved nitrogen balance in the MCT group, and less weight loss in the postoperative period also was observed in this group. During the fat clearance test, the serum ketone concentrations were significantly higher in the MCT than the LCT group. The improvement in nitrogen retention may be associated with increasing ketone and insulin levels. Fat emulsions containing 50% MCT are safe for use in parenteral nutrition and may provide an alternate fuel that improves protein metabolism.     

Influences of endotoxin on oxidation of fatty acid in rabbits: a comparison between medium chain- and long chain-fatty acids

Medium chain triglyceride emulsion (MCT) which is composed of 10% emulsion of tricaprylin (C8) or long chain triglyceride emulsion (LCT, 10% Intralipos) was infused intravenously to 20 rabbits for a period of 180 min (n = 10; MCT, n = 10; LCT). Five rabbits of each group were also given lipopolysaccharide (LPS B, E. Coli 055: B5, Difco Laboratories, Detroit Michigan, U.S.A.) at a rate of 0.3mg/kg/hr to a total dose of 0.9 mg/kg. The production of ketone-bodies (acetoacetate and beta-hydroxybutyrate) was quantified. MCT was more easily oxidized than LCT, regardless of the administration of LPS. Oxidation of LCT was suppressed by the administration of LPS, while that of MCT was not suppressed. In the presence of LPS, MCT caused a more pronounced decrease in the arterial ketone body ratio (acetoacetate/beta-hydroxybutyrate) than LCT. These results indicate that MCT seems to be a better energy source than LCT under the condition where the transport of fatty acid across the mitochondrial membrane was impaired by the administration of LPS.     

Parenteral nutrition in ventilated patients with chronic obstructive pulmonary disease: long chain vs medium chain triglycerides

AIM: The aim of this study was to assess the usefulness of a lipid formulation containing a physical mixture of medium (MCT) and long chain triglycerides (LCT) compared with a long chain triglycerides emulsion in patients affected by chronic obstructive pulmonary disease with acute respiratory failure. METHODS: Twenty-four patients requiring mechanical ventilation were randomly selected in 2 groups and received total parenteral nutrition. Twelve patients received a MCT/LCT emulsion (50:50), the others used a 100% LCT emulsion. Nutritional status, metabolic rate, time of ventilatory support and weaning were evaluated. RESULTS: Both groups showed an improvement of all nutritional parameters evaluated; oxygen uptake, carbon dioxide output and respiratory gas exchange ratio were similar in both groups. The duration of mechanical ventilation was not significantly different; however, the time of weaning in the MCT/LCT group was significantly shorter. The longer weaning time in the LCT group patients could be related to vasoactive intermediates deriving from long chain fatty acids. The T-cell subsets, which were evaluated for both groups, showed a significant decrease of T helper-T suppressor ratio in the LCT group. CONCLUSION: MCT/LCT emulsion is an effective lipid supplementation and should be considered the therapy of choice in COPD patients; however, the relationship between lipid emulsions administered and length of weaning requires further investigations.     

Hepatic reticuloendothelial function during parenteral nutrition including an MCT/LCT or LCT emulsion after liver transplantation – a double-blind study

It has been demonstrated that total parenteral nutrition (TPN) modulates the function of the hepatic reticuloendothelial system (RES). The objective of this study was to evaluate the impact of two different TPN lipid emulsions on the recovery of allograft RES function after orthotopic liver transplantation (OLTx). In a prospective, double-blind study, OLTx patients were randomly assigned to two treatment groups. Group I ( n=13) received a TPN regimen that included long-chain triglycerides (LCT). Group II ( n=9) received a TPN regimen that included a fat emulsion consisting of both medium-chain triglycerides (MCT) and LCT. At baseline, i.e., on days 2 or 3 after OLTx ( t1), before lipids for TPN were started, hepatic RES function was determined using the human serum albumin millimicrosphere technique (K-value, 1/min). A second measurement ( t2) was obtained after 7 days of TPN, including one of the study's two fat emulsions. The mean (+/- SD) K-value (1/min) was 0.48+/-0.16 in the LCT group and 0.55+/-0.28 in the MCT/LCT group at t1, and it improved to 0.62+/-0.21 in the LCT group and to 0.86+/-0.32 in the MCT/LCT group at t2. RES function recovery was significantly better in the MCT/LCT group ( P< or = 0.05). MCT/LCT emulsion appears to be the TPN fat emulsion of choice after OLTx as it seems to have less impact on hepatic RES recovery.     

中、长链脂肪乳剂对肝硬变家兔胆红素代谢及肝功能的影响

研究长链脂肪乳剂和中/长链混合脂肪乳剂二种不同肠外营养液支持下,观察血中游离脂肪酸浓度变化对胆红素和肝功能的影响。方法:21只新西兰大白兔经结扎胆总管制成胆源性肝硬化动物模型,随机分为三组:正常对照组(n=6);肝硬化肠外营养PN-LCT组(n=10);肝硬化肠外营养PN-MCT/LCT组(n=11)。两组的PN液所含热量及氮量均相等。在PN的第1、7天,用高效液相色谱(HPLC)测定PN后4h血中游离脂肪酸(FFA)浓度,并常规测定胆红素及白蛋白和肝脏酶学的变化。结果:肝硬变形成后,总胆红素及直接胆红素、丙氨酸转氨酶(ALT)、天门东氨酸转氨酶、碱性磷酸酶、γ-谷酰转肽酶均明显升高,而白蛋白明显下降,P<0.01。PN期间,FFA及FFA/白蛋白比值也明显升高,P<0.01。PN第7天时,LCT组直接胆红素及ALT和FFA/白蛋白比值均明显高于MCT/LCT组,P<0.01。结论:MCT/LCT乳剂可能是应用于肝硬变兔更为理想的能量来源。