Effects of Different Parenteral Nutrition Infusions in a Patient with Short Bowel Syndrome

本篇報告一位52歲因罹患短腸症综合症需完全依賴靜脈營養治療的女性，因接受不同成分比例的脂肪製劑导致肝功能不同的變化。在小腸切除與空腸造口後十三個月期間，我們追蹤病患的血中甘油三酯、肝臟酶水平、體重與臨床症狀。患者於小腸切除後前三個月初期使用的全靜脈脂肪乳劑成分比例為50%大豆油及50%中鏈脂肪酸，病人表示有心悸及頭暈的感覺，病人有肝功能異常及高甘油三酯血症，血清升至336 mg/dL，谷丙氨酸轉移酶（GPT）為145 U/L。在中止脂肪乳劑後，這些参数均得到改善。爾後九個月，我們將全靜脈營養脂肪乳劑比例改為20%大豆油及80%橄欖油，病人表示無心悸及頭暈的感覺，血清甘油三酯降為182 mg/dL，谷丙轉移酶（GPT）為109 U/L，體重由51公斤增至55公斤。本研究結果表明降低全靜脈營養中脂肪乳劑裡大豆油的比例，對病人的肝功能有好的影響。

關鍵字

脂肪乳劑；靜脈營養；短腸症；肝功能異常；高三酸甘油脂血症

並列摘要

In this case study, we demonstrate the effects of different lipid emulsions on liver function in a 52-year-old woman with short bowel syndrome who was totally dependent on parenteral nutrition. Over a 13-month period after small bowel resection and jejunostomy, we followed the patient's plasma triglycerides and liver enzyme levels as well as body weight and discomfort levels. During the first 3 months when parenteral nutrition including a lipid emulsion containing 50% soybean oil/50% medium-chain triglyerides was administered daily, the patient reported feeling unwell (experiencing dizziness and palpitations) and her triglycerides and liver enzyme levels rose to 366 mg/dL and 145 U/L (alanine aminotransferase [ALT]), respectively; these levels recovered when this emulsion was discontinued. For the following 9 months, an emulsion containing 80% olive oil and 20% soybean oil was administered, and the patient's triglycerides (182 mg/dL) did not increase to abnormal levels and liver enzyme levels were only mildly elevated (109 U/L). The patient felt well and her body weight increased from 51 kg to 55 kg during this period. These results suggest that parenteral nutrition with a reduced soybean oil content may better preserve liver function in patients with short bowel syndrome.

並列關鍵字

lipid emulsion ； parenteral nutrition ； short bowel syndrome ； abnormal liver function ； hypertriglyceridemia

國際替代計量

Effects of Different Parenteral Nutrition Infusions in a Patient with Short Bowel Syndrome

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