CAJ | 학술논문

目的观察Lipoplus(力保加)脂肪乳对胃肠肿瘤患者术后营养状况和早期炎性反应的影响.方法前瞻性入组2010年4月至2011年4月南京军区南京总医院普通外科收治的64例胃肠道肿瘤患者,按随机数字表法随机分为Lipoplus组和Lipofundin(力保肪宁)组,每组32例.术后1～5d,两组患者按等氮、等热量进行肠外营养支持.于术前及术后1、2、3、6d,检测营养指标(前白蛋白、视黄醇结合蛋白和氮平衡)和炎性反应指标[C反应蛋白和白细胞三烯(LTB5和LTB4)]；并观察患者术后全身炎性反应综合征(SIRS)、感染发生率、病死率、APACHEⅡ评分及术后住院时间等临床指标.结果术后1d,两组患者前白蛋白和视黄醇结合蛋白水平较术前明显降低;术后6d又明显升高(P＜0.05),并已达到正氮平衡.术后6d,两组患者C反应蛋白水平较术后3d明显下降(P＜0.05),且Lipoplus组较Lipofundin组下降趋势更为明显(P＜0.05)；Lipoplus组LTB5/LTB4较术后1d明显升高(P＜0.05),但Lipofundin组LTB5/LTB4的升高却未达到统计学意义(P＞0.05).Lipoplus组术后感染发生率(3.1％,1/32)和SIRS发生率(6.3％,2/32)低于Lipofundin组[分别为9.4％ (3/32)和15.6％(5/32)],APACHEⅡ评分(3.6±2.0)高于Lipofundin组(33±2.1),但差异均无统计学意义(均P＞0.05)；Lipoplus组术后住院时间则较Lipofundin组明显缩短[(6.4±1.1)d比(8.2±1.3)d,P＜0.05].结论 Lipoplus脂肪乳剂可显著改善胃肠肿瘤患者术后营养状况并降低术后炎性反应.
목적 관찰Lipoplus(력보가)지방유대위장종류환자술후영양상황화조기염성반응적영향.방법 전첨성입조2010년4월지2011년4월남경군구남경총의원보통외과수치적64례위장도종류환자,안수궤수자표법수궤분위Lipoplus조화Lipofundin(력보방저)조,매조32례.술후1～5d,량조환자안등담、등열량진행장외영양지지.우술전급술후1、2、3、6d,검측영양지표(전백단백、시황순결합단백화담평형)화염성반응지표[C반응단백화백세포삼희(LTB5화LTB4)]；병관찰환자술후전신염성반응종합정(SIRS)、감염발생솔、병사솔、APACHEⅡ평분급술후주원시간등림상지표.결과 술후1d,량조환자전백단백화시황순결합단백수평교술전명현강저;술후6d우명현승고(P＜0.05),병이체도정담평형.술후6d,량조환자C반응단백수평교술후3d명현하강(P＜0.05),차Lipoplus조교Lipofundin조하강추세경위명현(P＜0.05)；Lipoplus조LTB5/LTB4교술후1d명현승고(P＜0.05),단Lipofundin조LTB5/LTB4적승고각미체도통계학의의(P＞0.05).Lipoplus조술후감염발생솔(3.1％,1/32)화SIRS발생솔(6.3％,2/32)저우Lipofundin조[분별위9.4％ (3/32)화15.6％(5/32)],APACHEⅡ평분(3.6±2.0)고우Lipofundin조(33±2.1),단차이균무통계학의의(균P＞0.05)；Lipoplus조술후주원시간칙교Lipofundin조명현축단[(6.4±1.1)d비(8.2±1.3)d,P＜0.05].결론 Lipoplus지방유제가현저개선위장종류환자술후영양상황병강저술후염성반응.
Objective To investigate the effect of Lipoplus on postoperative nutritional status and inflammatory response in patients with gastrointestinal malignancies.Methods Sixty-four patients with gastrointestinal mahgnancies were randomized using random digit table to receive isonitrogenous,isocaloric total parenteral nutrition for 5 days including either Lipoplus or Lipofundin with 32 patients in each group.Blood samples were obtained before the surgery,postoperative days 1,2,3,and 6 to evaluate the nutritional status (prealbumin,retinol binding protein,and nitrogen balance) and inflammatory response [ C-reaction protein (CRP),and leukotriene (LTB) 5,LTB4 ].The incidence of postoperative systemic inflammatory response syndrome (SIRS),infection,postoperative complications,mortality,APACHEII score,length of hospital stay and other clinical indicators were recorded.Results On postoperative day 1,prealbumin and retinol binding protein were significantly lower as compared to preoperative levels.These parameters increased significantly (P＜0.05) on postoperative day 6 and the nitrogen balance was positive.On postoperative day 6,CRP was significantly lower in both groups as compared to postoperative day 3 (P＜0.05),and the decrease was more prominent in Lipoplus than Lipofundin (P＜0.05).There was a significant increase in LTB5/LTB4 as compared to postoperative day 1 (P＜0.05) in the Lipoplus group,however the increase was not statistically significant in the Lipofundin group (P＞0.05).The incidence of postoperative infection was significantly lower in the Lipoplus group (3.1％ vs.6.3％,P＜0.05),as was that of SIRS (9.4％ vs.15.6％,P＜0.05).The APACHEII score was higher in the Lipoplus group but the difference was not statistically significant (3.6±2.0 vs.3.3±2.1,P＞0.05).The length of hospital stay was significantly shorter in Lipoplus group [(6.4±1.1) d vs.(8.2±1.3) d,P＜0.05].Conclusion Lipoplus can improve the postoperative nutritional status and minimize the inflammatory response in patients with gastrointestinal malignancies.