南方医科大学学报
南方醫科大學學報
남방의과대학학보
Journal of Southern Medical University
2015年
9期
1312-1315
,共4页
多种油脂肪乳%肠外营养%重症%炎症介质%肝功能
多種油脂肪乳%腸外營養%重癥%炎癥介質%肝功能
다충유지방유%장외영양%중증%염증개질%간공능
parenteral lipid emulsion%parenteral nutrition support%intensive care%inflammatory mediators%liver function
目的：探讨术后应用多种油脂肪乳（SMOF）的肠外营养治疗对胃肠外科重症患者预后的影响。方法将72例胃肠外科重症患者按照前瞻、随机、对照原则分为SMOF组及对照组，分别给予含SMOF及中、长链脂肪乳的等热量的肠外营养支持，于使用前及使用后第4、9天分别检测丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、白蛋白（ALB）、C反应蛋白（CRP）、白介素6（IL-6）及外周血内毒素水平，并统计两组患者的重症监护病房（ICU）住院时间、抗菌素使用时间及术后并发症发生率。计量数据采用独立样本t检验，计数数据采用χ2检验。结果术后第4天，SMOF组CRP、TL-6低于对照组（P<0.05）；术后第9天，SMOF组ALT、TBIL、CRP、TL-6低于对照组（P<0.05），术后两组患者ALB及外周血内毒素水平无显著性差异。术后ICU入住时间、抗菌素使用时间，SMOF组低于对照组（P<0.05），术后感染性并发症，SMOF组低于对照组，但二者之间无统计学意义（χ2=1.047，P>0.05）。结论胃肠外科重症患者术后应用添加SMOF的肠外营养能够有效减少炎症介质释放、保护重要脏器功能，减少术后并发症，改善患者的预后。
目的：探討術後應用多種油脂肪乳（SMOF）的腸外營養治療對胃腸外科重癥患者預後的影響。方法將72例胃腸外科重癥患者按照前瞻、隨機、對照原則分為SMOF組及對照組，分彆給予含SMOF及中、長鏈脂肪乳的等熱量的腸外營養支持，于使用前及使用後第4、9天分彆檢測丙氨痠氨基轉移酶（ALT）、總膽紅素（TBIL）、白蛋白（ALB）、C反應蛋白（CRP）、白介素6（IL-6）及外週血內毒素水平，併統計兩組患者的重癥鑑護病房（ICU）住院時間、抗菌素使用時間及術後併髮癥髮生率。計量數據採用獨立樣本t檢驗，計數數據採用χ2檢驗。結果術後第4天，SMOF組CRP、TL-6低于對照組（P<0.05）；術後第9天，SMOF組ALT、TBIL、CRP、TL-6低于對照組（P<0.05），術後兩組患者ALB及外週血內毒素水平無顯著性差異。術後ICU入住時間、抗菌素使用時間，SMOF組低于對照組（P<0.05），術後感染性併髮癥，SMOF組低于對照組，但二者之間無統計學意義（χ2=1.047，P>0.05）。結論胃腸外科重癥患者術後應用添加SMOF的腸外營養能夠有效減少炎癥介質釋放、保護重要髒器功能，減少術後併髮癥，改善患者的預後。
목적：탐토술후응용다충유지방유（SMOF）적장외영양치료대위장외과중증환자예후적영향。방법장72례위장외과중증환자안조전첨、수궤、대조원칙분위SMOF조급대조조，분별급여함SMOF급중、장련지방유적등열량적장외영양지지，우사용전급사용후제4、9천분별검측병안산안기전이매（ALT）、총담홍소（TBIL）、백단백（ALB）、C반응단백（CRP）、백개소6（IL-6）급외주혈내독소수평，병통계량조환자적중증감호병방（ICU）주원시간、항균소사용시간급술후병발증발생솔。계량수거채용독립양본t검험，계수수거채용χ2검험。결과술후제4천，SMOF조CRP、TL-6저우대조조（P<0.05）；술후제9천，SMOF조ALT、TBIL、CRP、TL-6저우대조조（P<0.05），술후량조환자ALB급외주혈내독소수평무현저성차이。술후ICU입주시간、항균소사용시간，SMOF조저우대조조（P<0.05），술후감염성병발증，SMOF조저우대조조，단이자지간무통계학의의（χ2=1.047，P>0.05）。결론위장외과중증환자술후응용첨가SMOF적장외영양능구유효감소염증개질석방、보호중요장기공능，감소술후병발증，개선환자적예후。
Objective To investigate the effect of parenteral nutrition support with a lipid emulsion formulation (containing soybean oil, medium chain triglycerides, olive oil, and fish oil [SMOF]) in intensive care patients following major gastrointestinal surgeries. Methods According to a randomized, prospective and case-controlled design, 72 intensive care patients following major gastrointestinal surgeries between January and December, 2014 were randomized equally into SMOF group and control group to receive parenteral nutrition support with SMOF and medium or long chain lipid emulsion, respectively. Before and at 4 and 9 days after commencement of parenteral nutrition support, the patients were examined for alanine aminotransferase (ALT), total bilirubin (TBIL), albumin (propagated), C-reactive protein (CRP), interleukin 6 (IL-6), and endotoxin levels. The patients' average length of stay in intensive care unit (ICU), the days of using antibiotics, and the incidence rate of postoperative complication were recorded. Results On day 4 postoperatively, the levels of CRP and IL-6 were significantly lower in SMOF group than in the control group (t=2.669 and 2.676, respectively; P<0.05), and on day 9, the patients in SMOF group showed significantly lower levels of ALT, TBIL, CRP and IL-6 (t=2.487, 3.497, 3.762, 2.180, respectively;P<0.05) than the control group, but ALB and endotoxin levels remained comparable between the two groups. The average length of stay in ICU and the days of using antibiotics were significantly shorter in SMOF group than in the control group (t=2.94 and 2.17, respectively;P<0.05);SMOF group showed a lower incidence of postoperative infections than the control group, but the difference was not statistically significant (χ2=1.047, P>0.05). Conclusion For intensive care patients following major gastrointestinal surgeries, postoperative parenteral nutrition support with SMOF can effectively reduce the release of inflammatory mediators, protect important visceral functions, reduce postoperative complications, shorten the length of ICU stay, and improve the prognosis of the patients.
