CAJ | 학술논문

作为肠外营养的重要组成部分，脂肪乳剂具有避免必需脂肪酸缺乏和作为高密度能量来源的作用。选择脂肪乳剂非常复杂，主要是因为不同的脂肪乳剂由不同的脂肪酸构成，可通过不同途径改变机体的免疫反应。同时其生物化学特性不同，对炎症反应有明显影响。应依据患者的代谢状态选择脂肪酸的类型和脂肪乳剂的供给量。越来越多的证据提示，对处于高代谢状态的危重患者，应避免使用以大豆油为原料的标准脂肪乳剂，而选择含中链甘油三酯、橄榄油或鱼油的脂肪乳剂，以减少具有促进炎症反应和免疫抑制作用的ω-6多不饱和脂肪酸的比例。尽管目前证据尚不足以作出对某种脂肪乳剂的特殊推荐意见，但作为二十碳五烯酸和二十二碳六烯酸的来源，含鱼油的脂肪乳剂能更好地调节免疫反应，对减少危重患者住ICU时间有重要作用。
작위장외영양적중요조성부분，지방유제구유피면필수지방산결핍화작위고밀도능량래원적작용。선택지방유제비상복잡，주요시인위불동적지방유제유불동적지방산구성，가통과불동도경개변궤체적면역반응。동시기생물화학특성불동，대염증반응유명현영향。응의거환자적대사상태선택지방산적류형화지방유제적공급량。월래월다적증거제시，대처우고대사상태적위중환자，응피면사용이대두유위원료적표준지방유제，이선택함중련감유삼지、감람유혹어유적지방유제，이감소구유촉진염증반응화면역억제작용적ω-6다불포화지방산적비례。진관목전증거상불족이작출대모충지방유제적특수추천의견，단작위이십탄오희산화이십이탄륙희산적래원，함어유적지방유제능경호지조절면역반응，대감소위중환자주ICU시간유중요작용。
Intravenous lipid emulsions( LEs) are relevant for patients receiving parenteral nutrition because they prevent the depletion of essential fatty acids(FAs) and as a highly dense energy source. The prescription of LEs is complex,due mainly to their distinct FAs components,which may alter the immune re-sponse in different ways and distinctly influence inflammation according to their biochemical properties. The patient′s metabolic profile should guide the type of FAs and amount of lipids that are provided. For critically ill hypermetabolic patients,growing evidence indicates that standard LEs based solely on soybean oil should be avoided in favor of new LEs containing medium-chain triglycerides,olive oil,or fish oil to decrease the provision of potentially inflammatory/immunosuppressiveω-6 polyunsaturated fatty acids. As sources of eico-sapentaenoic and docosahexaenoic acids,LEs containing fish oil may be important for critically ill patients be-cause they allow better modulation of the immune response and likely reduce the length of intensive care unit stay. However,current evidence precludes the recommendation of a specific LE for clinical use in this patient population.