CAJ | 학술논문

目的研究脂肪乳剂在老年肿瘤患者术后肠外营养相关肝功能损伤(PNALD)中的作用.方法回顾性分析2003年1月至2008年12月仁济医院402例老年肿瘤患者接受肠外营养后肝功能损伤的发生情况.纳入标准:年龄≥60岁;确诊为恶性肿瘤,无远处转移且接受肠外营养前肿瘤已完全切除;接受肠外营养前患者的肝肾功能正常;接受肠外营养≥7 d;采用"全合一"方式配制肠外营养液,且经过中心静脉输注.排除标准:病毒性肝炎患者;接受肠外营养期间患者死亡.年龄(71.7±6.8)岁,平均接受了(10.2±5.9)(7～61)d肠外营养支持.77.4%(311/402)患者使用了脂肪乳剂,22.6%(91/402)患者输注了不含脂肪乳剂的肠外营养液.碳水化合物、脂肪和氨基酸的平均供给量分别为(1.8±0.7)、(0.9±0.4)和(0.7±0.2)g·kg-1·d-1.平均供热量和热氮比分别为(69.8±27.2)kJ·kg-1·d-1和(660.4±255.4)kJ∶1g氮.结果 402例老年肿瘤患者PNALD的发生率为15.2%(61/402).接受不含脂肪乳剂肠外营养支持老年患者PNALD的发生率为8.8%(8/91),而接受脂肪乳剂老年患者PNALD的发生率为17.0%(53/311),两者的差异无统计学意义(χ2=3.72,P＞0.05).脂肪乳剂种类和用量对PNALD发生率无显著影响(P＞0.05).Logistic回归分析显示,体温升高天数(P＜0.001)、丙氨酸氨基转移酶(P＜0.001)和γ-谷氨酰转移酶(P＜0.001)是PNALD发生的危险因素.结论给老年肿瘤患者术后应用脂肪乳剂是安全的,且对PNALD的发生未产生显著影响.
목적 연구지방유제재노년종류환자술후장외영양상관간공능손상(PNALD)중적작용.방법 회고성분석2003년1월지2008년12월인제의원402례노년종류환자접수장외영양후간공능손상적발생정황.납입표준:년령≥60세;학진위악성종류,무원처전이차접수장외영양전종류이완전절제;접수장외영양전환자적간신공능정상;접수장외영양≥7 d;채용"전합일"방식배제장외영양액,차경과중심정맥수주.배제표준:병독성간염환자;접수장외영양기간환자사망.년령(71.7±6.8)세,평균접수료(10.2±5.9)(7～61)d장외영양지지.77.4%(311/402)환자사용료지방유제,22.6%(91/402)환자수주료불함지방유제적장외영양액.탄수화합물、지방화안기산적평균공급량분별위(1.8±0.7)、(0.9±0.4)화(0.7±0.2)g·kg-1·d-1.평균공열량화열담비분별위(69.8±27.2)kJ·kg-1·d-1화(660.4±255.4)kJ∶1g담.결과 402례노년종류환자PNALD적발생솔위15.2%(61/402).접수불함지방유제장외영양지지노년환자PNALD적발생솔위8.8%(8/91),이접수지방유제노년환자PNALD적발생솔위17.0%(53/311),량자적차이무통계학의의(χ2=3.72,P＞0.05).지방유제충류화용량대PNALD발생솔무현저영향(P＞0.05).Logistic회귀분석현시,체온승고천수(P＜0.001)、병안산안기전이매(P＜0.001)화γ-곡안선전이매(P＜0.001)시PNALD발생적위험인소.결론 급노년종류환자술후응용지방유제시안전적,차대PNALD적발생미산생현저영향.
Objective　To evaluate the effects of lipid emulsion on parenteral nutrition associated liver dis ease (PNALD) in old tumor patients. Methods　A retrospective study was performed with 402 patients in Renji Hospital from January 2003 to December 2008. Patients were retrieved according to the following criteria: (1)age ≥60 years; (2) confirmed diagnosis of tumor, had no evidence of metastasis, and tumor was completely resected before receiving parenteral nutrition; (3) liver and kidney function was in normal range before receiving parenteral nutrition; (4) parenteral nutrition days ≥7; and (5) parenteral nutrition was infused in "all in one" bag via central venous. Patients with history of viral hepatitis or died in parenteral nutrition episode were excluded. These 402 patients aged (71.7 ±6.8) years and the average parenteral nutrition time was (10. 2 ±5.9) (range, 7-61 )days. In 311 patients (77.4％), non-protein calorie was obtained from carbohydrate and lipid and 91 patients (22. 6％ ) just obtained non-protein calorie from carbohydrate.　Results　The total prevalence of PNALD was 15.2％ (61/402). The prevalence of PNALD was 8.8％ (8/91) in patients receiving parenteral regiment without lipid and 17.0％ (53/311) in patients receiving parenteral nutrition with lipid, and there was no significant difference in prevalence of PNALD between two groups (χ2 = 3.72, P = 0.07 ). Lipid type and amount showed no significant effects on PNALD ( P ＞ 0.05 ). The fever days ( P ＜ 0. 001 ), baseline level of alanine transaminase (P ＜0. 001 ) and γ-glutamyltransferase (P ＜0. 001 ) were risk factors for liver injury by logistic regression. Conclusion　Lipid emulsion can be safely used in old tumor patients without affecting the occurrence of PNALD.