CAJ | 학술논문

目的研究富含结构脂肪乳的肠外营养支持在老年胆道感染患者急性发病期应用的安全性和对机体的影响. 方法选择我院高龄(≥80岁)胆道感染患者62例,早期均采取保守治疗,其营养支持随机分为结构脂肪乳(STG)组和物理混合的中长链脂肪乳(MCT/LCT)组进行肠外营养治疗5d.对比观察两组患者肝酶学、血脂水平、氮平衡、血胰岛素及血糖的水平变化. 结果两组患者肝酶学指标、血三酰甘油、空腹血糖水平比较差异无统计学意义.总胆红素(TBIL)输注后均有不同程度的升高,但STG组随后下降,输注后第7天MCT/LCT组下降速度慢于STG组(P＜0.05).总胆固醇水平在输注后第4天,STG组下降水平与MCT/LCT组比较差异有统计学意义(P＜0.05).5d累积氮平衡量STG组和MCT/LCT组(4.7±2.2)g和(2.8±0.7)g,两组比较差异有统计学意义(P＜0.05).STG组输注后第1、4、7天对空腹血胰岛素水平影响波动较小,优于MCT/LCT组. 结论富含结构脂肪乳的肠外营养在老年患者胆道感染的应激期在提供能量的同时其有利于保持机体氮平衡,对空腹血胰岛素水平影响波动较小,短期的营养支持可能较好的在肝脏中耐受,对肝脏酶学的变化影响不大.
목적 연구부함결구지방유적장외영양지지재노년담도감염환자급성발병기응용적안전성화대궤체적영향. 방법 선택아원고령(≥80세)담도감염환자62례,조기균채취보수치료,기영양지지수궤분위결구지방유(STG)조화물리혼합적중장련지방유(MCT/LCT)조진행장외영양치료5d.대비관찰량조환자간매학、혈지수평、담평형、혈이도소급혈당적수평변화. 결과 량조환자간매학지표、혈삼선감유、공복혈당수평비교차이무통계학의의.총담홍소(TBIL)수주후균유불동정도적승고,단STG조수후하강,수주후제7천MCT/LCT조하강속도만우STG조(P＜0.05).총담고순수평재수주후제4천,STG조하강수평여MCT/LCT조비교차이유통계학의의(P＜0.05).5d루적담평형량STG조화MCT/LCT조(4.7±2.2)g화(2.8±0.7)g,량조비교차이유통계학의의(P＜0.05).STG조수주후제1、4、7천대공복혈이도소수평영향파동교소,우우MCT/LCT조. 결론 부함결구지방유적장외영양재노년환자담도감염적응격기재제공능량적동시기유리우보지궤체담평형,대공복혈이도소수평영향파동교소,단기적영양지지가능교호적재간장중내수,대간장매학적변화영향불대.
Objective To investigate the safety and efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection.Methods 62 elderly patients with acute biliary tract infection under conservative therapy were randomly divided into structured triglycerides (ST) group and medium-chain triglycerides plus long-chain triglycerides (MCT/LCT) group.Patients underwent parenteral nutrition for 5 days.Levels of hepatic enzymes,blood triglycerides,nitrogen balance,fasting blood insulin and glucose were compared between the two groups after 5 days of parenteral nutrition.Results There were no significant differences in levels of hepatic enzymes,blood triglycerides and fasting blood glucose between ST group and MCT/LCT group.Plasma total bilirubin (T-Bill) levels were increased in the two groups,and T-Bill level dropped faster in the ST group than in the MCT/LCT group after 7 days of parenteral nutrition(P＜ 0.05).The difference in total cholesterol level dropping was significant between ST group and MCT/ LCT group (P＜0.05).The cumulative nitrogen balance for 5 days had significant difference between ST and MCT/LCT groups [(4.7-±-2.2) g vs.(2.8±0.7) g,P＜0.05].STG group versus MCT/LCT group had less fluctuation of fasting blood insulin level after 1,4 and 7 days of parenteral nutrition.Conclusions In the acute phase of biliary tract infection in elderly patients,ST-based parenteral nutrition can provide energy and help maintain nitrogen balance,with a little fluctuation of fasting blood insulin level.Short-term nutritional support may have better tolerance in the liver and has little effect on the change of hepatic enzymes.