创伤应激后的脂肪代谢

创伤后脂肪代谢的特点是消化吸收障碍、肝脏摄取减少、脂肪动员、肝脏输出、肝外组织摄取、脂肪氧化产能、甘油三酯水解-再酯化循环增加等,这些变化机制与交感神经兴奋、胰岛素抵抗和炎症反应有关,使脂肪取代葡萄糖成为主要能源物质.补充葡萄糖可以抑制脂肪氧化但不能抑制脂肪水解和再酯化,补充长链脂肪乳能预防必需脂肪酸缺乏,补充胆固醇能促进脂肪乳吸收和利用.通过干预脂肪代谢,有望改善创伤的预后.

Fat metabolism following traumatic stress

Lipids metabolism can change after traumas such as operation or injury.The process is com-prised of accelerated hydrolysis of triglyceride in adipose tissue,accelerated absorption of fatty acids by extra-he-patic tissue,improved lipid oxidation rate,and augmented re-esterification of fatty acids in liver and adipose tis-sue.Mechanisms of lipid mobilization include sympathetic stimulation,insulin resistance,and inflammation.How-ever,lipid absorption by liver and intestine is inhibited after trauma.Through post-trauma nutritional support,glu-cose administration improves re-esterification of fatty acids and inhibits lipid oxidation without affecting lipolysis.Fat emulsion infusion inhibits both absorption and secretion of triglyceride in liver.Therefore,clinicians should a-void over-alimentation of glucose and fat to prevent lipid overload,particularly in liver. Intervention of post-trau-matic lipid metabolism improves the outcomes:administration of long-chain triglycerides can prevent exhaustion of essential fatty acids,and administration of cholesterol can improve absorption and oxidation of fat emulsion.