外科病人围手术期血脂代谢的变化及其临床意义

对二组外科择期手术病人围手术期血浆游离脂肪酸即软脂酸（C16：0）、硬脂酸（C18：0）、油酸（C18：0）、亚油酸（C18：2）、花生四烯酸（C20：4）和甘油三脂及胆固醇水平变化的观察，发现手术后早期即有血脂水平的全面降低。血脂的降低随创伤应激的加重而具显著性且持久，提示在创伤应激早期机体主要通过利用血脂而获得能量，同时血糖应激性升高以保证神经细胞和红细胞的能量供应，并减少了乳酸生成，有利于维持重要的生命中枢功能和体液内环境稳定。本研究还发现，创伤后存在着显著而持久的低胆固醇血症，且血胆固醇水平与创伤程度及病人预后有较密切关系。创伤后在保证机体氧合状态正常的前提下，早期补充脂肪酸（特别是多不饱和脂肪酸）和胆固醇，将有助于减轻机体组织的分解代谢，稳定细胞结构和功能，保护机体内环境，防止多器官功能障碍的发生。

The perioperative metabolic changes of blood-lipid in surgical patients

The plasma free fatty acid (FFA), triglyceride (TG) and choesterol (CHO) of surgical patients were measured respectively before and 1, 3, 5 days after operation. The patients were divided in-2 groups: group A-minor operation (hernioplasty, saphenectomy...), group B-major operation (colonectomy, gastrictomy). The blood-lipid had an overall decrease immediately after surgery, which was correlated with the severity of trauma and stress. It was indicated that, at the early stage after trauma, the body get energy mainly from blood-fat, the glucose were saved for the energy need of brain and erythrocytes, which are very important for protecting the normal function of vital organs and stabilizing the homeostasis. It was also shown a significant hypocholestemia after major surgery, and this hypocholestemia was a sensitive marker of severity of trauma as well as the prognosis of patient. After surgical stress,under the normal oxygenation, early supplement of fatty acid especially the poly-unsaturated fatty acid (PUFA) and cholesterol would be benefit to decrease the body catabolism, to protect the structure and function of cell membrane as well as homeotasis and to prevent MODS.