比較全靜脈營養輸入中鏈與長鏈三酸甘油酯脂肪乳劑對重症病患術後生化指標及預後之影響

Comparison of Parenteral Medium-chain and Long-chain Triglyceride Fat Emulsions on Biochemical Marker and Clinical Outcome in Critically Ⅲ Patients

孫文蕙(Wen-Huei Sun) ； 劉麗娟(Lie-Chuan Liu) ； 林恆甫(Heng-Fu Lin) ； 洪芳明(Fang-Ming Hung) ； 葉松鈴(Sung-Ling Yeh)

《臺灣營養學會雜誌》 34卷2期 (2009/06) Pp. 50-57

https://doi.org/10.6691/NSJ.200906_34(2).0003

摘要

外科手術或創傷患者常因疾病本身及手術形式等因素而影響進食，創傷所造成之傷害也會使身體產生異化作用及營養素代謝上的異常，而創傷患者及早給予適當的營養支持可幫助傷口癒合、降低感染率並縮短住院天數。全靜脈營養(total parenteral nutrition, TPN)是一種不經由腸道供給營養素的營養支持方式，常用於腸道功能喪失的重症病人。TPN的配方中脂肪可提供必須脂肪酸，且是能量的重要來源。過去所使用的脂肪乳劑以富含n-6脂肪酸的long-chain triglyceride(LCT)為主，但因medium-chain triglyceride (MCT)氧化速度快，也有研究認為MCT/LCT混合而成的脂肪乳劑可作為創傷病人較佳的能量來源。本研究主要探討LCT與MCT/LCT兩種不同的脂肪乳劑，對重症病患生化指標及預後的影響。本研究是以回溯方法篩選2004年8月到2006年12月間於－教學醫院之一般外科加護病房接受TPN至少七天的患者，共分成兩組，一組輸入的脂肪乳劑為LCT(n=16)，一組為MCT/LCT(n=17)。分別收集使用TPN前及七天後血中各項生化檢驗值及住院天數等資料。研究結果顯示，MCT/LCT組與LCT組血中白蛋白與轉鐵蛋白TPN前後兩組間沒有統計差異，但MCT/LCT組的白蛋白在TPN後顯著較高。在生化數值方面血中三酸甘油酯(triglyceride)，麩胺酸萃醋酸轉胺基酶(AST)、麩了胺酸丙酮酸轉胺基酶(ALT)、膽紅素(Bilirubin)、白血球計數、淋巴球計數，兩組間不論TPN前後的比較上均無統計差異。兩組TPN使用天數、術後住加護病房天數及住院天數亦無差異。本研究結果顯示使用MCT/LCT與LCT兩種不同的脂肪乳劑，對重症病患的血液生化指標及預後的影響無顯著差異。

關鍵字

重症病患 ； 全靜脈營養 ； 長鏈三酸甘油酯 ； 中鏈三酸甘油酯

並列摘要

Patients undergoing major surgery may develop malnutrition because of reduce intake result from hypermetabolism and metabolic dysfunction. Artificial nutritional support is necessary for these patients in order to decrease the susceptibility to infection, enhance wound healing and shorten hospital stay. Total parenteral nutrition (TPN) is widely used for the treatment of nutritional depletion in critically ill patients. Fat emulsions used in TPN not only provide essential fatty acids but also the main energy source for such patients. The most common fat emulsions consist of long-chain triglyceride (LCTs), which are abundant in n-6 fatty acids. Because medium-chain triglycerides (MCTs) are rapidly oxidized in the body, a combination of MCT/LCT is thought to be a better fuel source for surgical patients. This is a retrospective study to compare the effects of LCT and MCT/LCT fat emulsions on surgical patients with TPN as the main nutrition support. Thirty-three intensive care unit (ICU) patients were included, including 16 patients in LCT group, 17 in MCT/LCT group. The energy intake and macronutrient distribution were similar in the 2 groups. Plasma albumin, transferrin, triglyceride, bilirubin, alanine aminotransferase, aspartate aminotransferase levels, the white cell count, the Iymphocyte count were collected before and 7 days after TPN in all patients. The results showed no differences in these parameters between the LCT and MCT/LCT groups were observed after different fat emulsions were administered for 7 days. Compared to the levels before TPN, the MCT/LCT group had higher plasma albumin levels 7 days after TPN, whereas that was not found in the LCT group. There were no differences in the duration of the number of days in the ICU or the length of the hospital stay between the 2 groups. These results suggest that compared to the LCT group, the influences of MCT/LCT administration in biochemical parameters and clinical outcome were not obvious in critically ill patients.

並列關鍵字

critically ill patients ； total parenteral nutrition ； long-chain triglyceride ； medium-chain triglyceride