不同配方TPN对胆源性胰腺炎胆囊收缩及胆汁酸成分的影响

目的：探讨各种完全胃肠外营养（TPN）对胆源性胰腺炎胆囊收缩及胆汁酸成分改变的作用。方法：选择胆源性胰腺炎住院病人共86例，在常规治疗相同的基础上，随机分成四组，TPN支持分别为仅用糖盐水（GNS组）、糖盐水加用7％凡命（VM组）、糖盐水加用20％英脱利匹特（IL组）、糖盐水加用7％凡命及20％英脱利匹特（VM＋IL组）。B超测量胆囊体积及计算最大胆囊排空率（MGER），气相色谱法检测胆汁游离脂肪酸（FFA）。结果：发现VM＋IL组及VM组与GNS及IL组比较MGER显著升高，差异显著（P＜0．05）；VM＋IL组及IL组与GNS组比较，各种胆汁FAA构成比较差异显著（P＜0．05）。结论：TPN中加入VM＋IL或VM会促进胆囊排空，加入VM＋IL或IL会减轻胆汁FFA变化程度，均对胆石形成或增大可能有预防作用。

Effects of total parenteral nutrition on the gallbladder contraction and bile acid ingredient changes in the patients of biliogenic pancreatitis

Objectives:To observe the effects of total parenteral nutrition(TPN) on gallbladder contraction and bile acid ingredient changes in the patients of biliogenic pancreatitis. Methods:86 patients of biliogenic pancreatitis on routine treatment were divided into 4 groups randomly,and TPN supports were given.Glucose in normal saline(GNS) was used only in the first group,7% Vamin(VM)+GNS(VM+IL) used in the second group,20% Interlipid(IL)+GNS(VM+IL) used in the third group and 7%VM+20% IL+GNS used in the fourth group.The volume of gallbladder and the maximum gallbladder emptying rate(MGER) were measured by type B ultrasonograph.The free fatty acid(FFA) in bile was detected by gas chromatography. Results:MGERs were significantly higher in the second and fourth group than in the first and third group( P <0.05).There were significantly differences of free fatty acid ingredients in bile between the groups using VM or VM+IL and the group using GNS( P <0.05). Conclusions:VM+IL or VM in TPN can promote the gallbladder emptying. VM+IL or IL in TPN can decrease the changes of bile FFA.They may prevent the formation or enlargement of gall stone.