重病人的脂肪代谢和脂肪乳剂的应用.ppt

* 单核细胞HLA-DR 表达是免疫功能的重要指标之一， 对照组术后明显减弱而鱼油组没有明显减弱。 大的23例肠道手术病人随机分为2组，术后1-3天接受液体输注、4-5天肠外营养；实验组术前后共5天100ml/d鱼油（12） 观察指标：单核细胞HLA-DR，IL-6、呼吸氧爆发、LOS * Evangelos Tsekosa,1, Clemens Reuterb, Peter Stehlec,*, Gerhard Boeden. Perioperative administration of parenteral fish oil supplements in a routine clinical setting improves patient outcome after major abdominal surgery Clinical Nutrition 2004;23:325-330. TPN: On average: 1.5g/kg/d amino acids, 4g/kg/d glucose, 0.6g/kg/d lipids Groups: 1) Control (without ?-3-fatty acids) 2) + ?-3-fatty acids postoperatively 3) + ?-3-fatty acids pre- and postoperatively ? Dose: up to 100 ml Omegaven? * * 提高生存率 * 减少对抗生素的需求 * 肠外营养支持方案 Table 2. Regimen of total parenteral nutrition Day both groups control group study group Glucose Amino Acid lipids(lipovenos20%) lipids(lipovenos+omegaven) 1 2.0g/kg.d 0.5g/kg.d 0.8g/kg.d 0.64±0.16g/kg.d 2-5 3.0g/kg.d 1.2g/kg.d 1.0g/kg.d 0.8±0.2g/kg.d Wang Xinying, et al. JPEN 2008;32(3):236-241. SAP病人外周血脂肪酸谱的改变 EPA Wang Xinying, et al. JPEN 2008;32(3):236-241. 添加鱼油的肠外营养减轻SAP病人炎症反应 Wang Xinying, et al. JPEN 2008;32(3):236-241. 添加鱼油的肠外营养改善SAP病人器官功能 Table 4. The change of respiratory and liver function in both groups before and after TPN group OI WBC(×109/L) D1 D6 D1 D6 对照组 165±42 223±71* 14.16±0.98 13.22±1.14 实验组 177±36 262±60*# 15.09±1.34 12.49±1.14 * P0.05 Day 6 vs Day 1; # P0.05 SO-FO vs SO; OI oxygenation index Wang Xinying, et al. JPEN 2008;32(3):236-241. 添加鱼油的肠外营养改善SAP病人器官功能 结论 添加鱼油的肠外营养能够抑制SAP病人早期过 度的炎症反应，改善免疫功能，保护器官功能 总 结 脂肪乳剂不仅提供机体能量，还具有调节免疫的药理作用 临床上根据重病人的代谢特点，选择合适的脂肪乳剂进行营养治疗 * The FFA from the hydrolysis of the triglycerides penetrate directly into the tissue, used as energy source, and only a minor prop