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.

Influence of structured triglyceride on the surgical patients with liver disease

Objective To study the influence of structured triglyceride on liver function,nitrogen balance and protein metabolism in surgical patients with liver disease.Methods A prospective,random,and double-blind clinical trial was performed,and 86 surgical patients with liver disease were randomly divided into two groups according to the treatment of structured triglyceride (STG) or physical mixture of medium-chain/long-chain triglycerides (MCT/LCT) emulsion.Both groups received isonitrogenous and isocaloric parenteral nutrition (PN) in the six days after operation.The liver function,nitrogen balance and protein metabolism were compared between the two groups.Results There were no harmful to liver function in both groups.There is less influence on the biliburbin metabolism in STG group as compared with MCT/LCT group.The nitrogen balance in the STG group was significantly higher than those in the MCT/LCT group.The serum level of proteins in STG group back to the normal value on POD +4,while in MCT/LCT group was on POD +7.Conclusion STG can improve the nutrition of surgical patients with liver disease more rapidly than MCT/LCT.