中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
3期
304-307
,共4页
吕清泉%孙坚%叶亚林%马汉军
呂清泉%孫堅%葉亞林%馬漢軍
려청천%손견%협아림%마한군
脂肪乳剂%静脉注射用%肿瘤%急性时相蛋白%系统性炎症反应综合征
脂肪乳劑%靜脈註射用%腫瘤%急性時相蛋白%繫統性炎癥反應綜閤徵
지방유제%정맥주사용%종류%급성시상단백%계통성염증반응종합정
Fat emulsion%Intravenous%Neoplasms%Acute phase protein%Systemic inflammatory reaction syndrome
目的 探讨结构脂肪乳对消化道肿瘤术后患者急性时相蛋白和炎性细胞因子的影响.方法 选取2010年7月至2012年2月收治的消化道肿瘤术后患者80例,按分层抽样法随机分为结构脂肪乳组(观察组)和物理混合的中/长链脂肪乳组(对照组),每组40例,于术后第1～6d接受等氮、等热量的肠外营养.对比观察两组患者术后一般情况,分别于术前,术后1、7d检测血清急性时相蛋白和炎性细胞因子浓度.结果 在进行6d的肠外营养以后,两组患者生命体征、血常规、肝肾功能、血脂等均在正常范围,观察组术后感染相关并发症发生率[12.5％ (5/40)]较对照组[25.0％ (10/40)]低,术后住院时间[(12.9±0.7)d]较对照组[(13.1±0.9)d]短,但差异均无统计学意义(P均＞0.05).两组术后1d血清白蛋白(ALB)、前白蛋白(PAB)和转铁蛋白(TRF)浓度较术前明显降低,C反应蛋白(CRP)和纤维蛋白原(FIB)浓度较术前明显升高,其后逐渐恢复；观察组术后7d血清ALB、PAB、TRF、CRP和FIB浓度[(37.11±3.30) g/L、(0.25±0.08) g/L、(2.35±0.49) g/L、(21.84±16.76) mg/L、(3.95±1.23) g/L]与术后1d营养治疗前浓度[(31.52±2.92) g/L、(0.15±0.02) g/L、(1.90±0.54) g/L、(83.80±47.13) mg/L、(4.35±0.98) g/L]比较差异均有统计学意义(P均＜0.05)；与同期对照组浓度[(34.50±2.71) g/L、(0.18 ±0.05) g/L、(2.00 ±0.52) g/L、(41.36 ±23.49) mg/L、(4.76±2.35)g/L]比较差异均有统计学意义(P均＜0.05).两组术后1d血清IL-1、IL-2、IL-6及TNF-α浓度均有不同程度下降,随后逐渐回升,观察组术后7d血清IL-2、IL-6浓度[(987 ±203)、(277±107) ng/L]与术后1d营养治疗前浓度[(890±197)、(355±107) ng/L]有明显差异(P均＜0.05)；亦明显低于对照组[(1 347±195)、(752±187) ng/L](P均＜0.05)；术后7 d TNF-α浓度(197±98) ng/L与术后1d营养治疗前(167±79) ng/L比较差异无统计学意义(P＞0.05),但明显低于对照组浓度[342±106)ng/L,P＜0.05].结论 结构脂肪乳能有效改善消化道肿瘤术后急性时相蛋白质的合成,调控细胞因子产生和释放,将有利于顺利度过应激反应期.
目的 探討結構脂肪乳對消化道腫瘤術後患者急性時相蛋白和炎性細胞因子的影響.方法 選取2010年7月至2012年2月收治的消化道腫瘤術後患者80例,按分層抽樣法隨機分為結構脂肪乳組(觀察組)和物理混閤的中/長鏈脂肪乳組(對照組),每組40例,于術後第1～6d接受等氮、等熱量的腸外營養.對比觀察兩組患者術後一般情況,分彆于術前,術後1、7d檢測血清急性時相蛋白和炎性細胞因子濃度.結果 在進行6d的腸外營養以後,兩組患者生命體徵、血常規、肝腎功能、血脂等均在正常範圍,觀察組術後感染相關併髮癥髮生率[12.5％ (5/40)]較對照組[25.0％ (10/40)]低,術後住院時間[(12.9±0.7)d]較對照組[(13.1±0.9)d]短,但差異均無統計學意義(P均＞0.05).兩組術後1d血清白蛋白(ALB)、前白蛋白(PAB)和轉鐵蛋白(TRF)濃度較術前明顯降低,C反應蛋白(CRP)和纖維蛋白原(FIB)濃度較術前明顯升高,其後逐漸恢複；觀察組術後7d血清ALB、PAB、TRF、CRP和FIB濃度[(37.11±3.30) g/L、(0.25±0.08) g/L、(2.35±0.49) g/L、(21.84±16.76) mg/L、(3.95±1.23) g/L]與術後1d營養治療前濃度[(31.52±2.92) g/L、(0.15±0.02) g/L、(1.90±0.54) g/L、(83.80±47.13) mg/L、(4.35±0.98) g/L]比較差異均有統計學意義(P均＜0.05)；與同期對照組濃度[(34.50±2.71) g/L、(0.18 ±0.05) g/L、(2.00 ±0.52) g/L、(41.36 ±23.49) mg/L、(4.76±2.35)g/L]比較差異均有統計學意義(P均＜0.05).兩組術後1d血清IL-1、IL-2、IL-6及TNF-α濃度均有不同程度下降,隨後逐漸迴升,觀察組術後7d血清IL-2、IL-6濃度[(987 ±203)、(277±107) ng/L]與術後1d營養治療前濃度[(890±197)、(355±107) ng/L]有明顯差異(P均＜0.05)；亦明顯低于對照組[(1 347±195)、(752±187) ng/L](P均＜0.05)；術後7 d TNF-α濃度(197±98) ng/L與術後1d營養治療前(167±79) ng/L比較差異無統計學意義(P＞0.05),但明顯低于對照組濃度[342±106)ng/L,P＜0.05].結論 結構脂肪乳能有效改善消化道腫瘤術後急性時相蛋白質的閤成,調控細胞因子產生和釋放,將有利于順利度過應激反應期.
목적 탐토결구지방유대소화도종류술후환자급성시상단백화염성세포인자적영향.방법 선취2010년7월지2012년2월수치적소화도종류술후환자80례,안분층추양법수궤분위결구지방유조(관찰조)화물리혼합적중/장련지방유조(대조조),매조40례,우술후제1～6d접수등담、등열량적장외영양.대비관찰량조환자술후일반정황,분별우술전,술후1、7d검측혈청급성시상단백화염성세포인자농도.결과 재진행6d적장외영양이후,량조환자생명체정、혈상규、간신공능、혈지등균재정상범위,관찰조술후감염상관병발증발생솔[12.5％ (5/40)]교대조조[25.0％ (10/40)]저,술후주원시간[(12.9±0.7)d]교대조조[(13.1±0.9)d]단,단차이균무통계학의의(P균＞0.05).량조술후1d혈청백단백(ALB)、전백단백(PAB)화전철단백(TRF)농도교술전명현강저,C반응단백(CRP)화섬유단백원(FIB)농도교술전명현승고,기후축점회복；관찰조술후7d혈청ALB、PAB、TRF、CRP화FIB농도[(37.11±3.30) g/L、(0.25±0.08) g/L、(2.35±0.49) g/L、(21.84±16.76) mg/L、(3.95±1.23) g/L]여술후1d영양치료전농도[(31.52±2.92) g/L、(0.15±0.02) g/L、(1.90±0.54) g/L、(83.80±47.13) mg/L、(4.35±0.98) g/L]비교차이균유통계학의의(P균＜0.05)；여동기대조조농도[(34.50±2.71) g/L、(0.18 ±0.05) g/L、(2.00 ±0.52) g/L、(41.36 ±23.49) mg/L、(4.76±2.35)g/L]비교차이균유통계학의의(P균＜0.05).량조술후1d혈청IL-1、IL-2、IL-6급TNF-α농도균유불동정도하강,수후축점회승,관찰조술후7d혈청IL-2、IL-6농도[(987 ±203)、(277±107) ng/L]여술후1d영양치료전농도[(890±197)、(355±107) ng/L]유명현차이(P균＜0.05)；역명현저우대조조[(1 347±195)、(752±187) ng/L](P균＜0.05)；술후7 d TNF-α농도(197±98) ng/L여술후1d영양치료전(167±79) ng/L비교차이무통계학의의(P＞0.05),단명현저우대조조농도[342±106)ng/L,P＜0.05].결론 결구지방유능유효개선소화도종류술후급성시상단백질적합성,조공세포인자산생화석방,장유리우순리도과응격반응기.
Objective To explore the influence of structured lipid emulsion on acute phase protein and acute inflammatory reaction in gastrointestinal cancer patients after operation.Methods Eighty postoperative patients with gastrointestinal caner from July 2010 to February 2012 were randomly divided into observation group and control group,and 40 cases for each group.Patients in observation group were given structured lipid emulsion,while in control group were given physic mixture of medium-chain/long-chain triglycerides group.Meanwhile patients in both groups were received isonitrogenous and isocaloric parenteral nutrition for 6 days after operation.The general conditions after operation were recorded.Acute phase protein and acute inflammatory reaction were measured before operation,the 1 st day and 7th day after operation.Results After 6 days parenteral nutrition,the vital sign data,blood routine indices,liver and renal function,blood fat were back to normal values in two groups.There was no significant difference in the incidence of postoperative infection complication and hospitalization duration between observation group and control group (12.5％ (5/40) vs.25.0％ (10/40) ; (12.9 ± 0.7) d vs.(13.1 ± 0.9) d; P ＞ 0.05).The serum levels of Albumin (ALB),Prealbumin(PAB) and Transferrin(TRF) on the 1st day after operation in two groups were significantly lower than those before operation,while the serum levels of C reactive protein (CRP) and fibrinogen (Fib) were significantly higher,then gradually recovering.The serum levels of ALB,PAB,TRF,CRP,Fib on the 7th day after operation in observation group were (37.11 ± 3.30) g/L,(0.25 ± 0.08) g/L,(2.35 ± 0.49) g/L,(21.84±16.76) mg/L,(3.95 ± 1.23) g/L,significant different from those on the 1st day before nutrition therapy ((31.52±2.92) g/L,(0.15 ±0.02) g/L,(1.90 ±0.54) g/L,(83.80 ±47.13) mg/L,(4.35 ±0.98) g/L) and control group ((34.50 ±2.71) g/L,(0.18 ±0.05) g/L,(2.00 ±0.52) g/L,(41.36 ±23.49) mg/L,(4.76 ± 2.35) g/L; P ＜ 0.05).The serum levels of interleukin (IL)-1,IL-2,IL-6,tumor necrosis factor (TNF)-α decreased on the 1st day after operation of two groups,then gradually increasing.The serum levels of IL-2,IL-6 on the 7th day after operation in observation group were (987 ±203) ng/L) and (277 ± 107) ng/L,significant different from those on the 1st day before nutrition therapy ((890 ± 197) ng/L and (355 ± 107) ng/L;P ＜0.05),and lower than those in control group ((1 347 ± 195) ng/L,(752 ± 187) ng/L; P ＜0.05).The serum levels of TNF-α on the 7th day after operation in observation group was (197 ±98) ng/L,which was as same as that on the 1 st day before nutrition therapy ((167 ± 79) ng/L,P ＞ 0.05) and lower than this in control group((342 ± 106) ng/L;P ＜0.05).Conclusion Structured lipid emulsion can effectively improve the synthesis of acute phase protein in gastrointestinal cancer patients after operation,regulate the inflammatory cell factors producing and releasing,which is benefit to smoothly through stress reaction period.
