含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

摘要

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.%目的 研究含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中应用的安全性和有效性.方法 31例选择性肝叶切除术后患者按入院顺序用随机数字表法分为对照组(n=16)和研究组(n=15),两组患者在术后48～72 h后接受连续6 d的等氮、等热量的肠外营养支持.研究组使用含橄榄油脂肪乳,对照组使用标准的中/长链脂肪乳.分别于术前和术后第1天、第7天取患者清晨空腹外周静脉血,检测肝功能指标和血浆蛋白水平,并观察脂肪乳的安全性和术后患者恢复情况.结果 两组患者术前总胆红素、直接胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、总蛋白、白蛋白和前白蛋白具有可比性(P均>0.05).两组患者术后的安全性及肝功能指标差异均无统计学意义(P均>0.05),但研究组术后第7天血浆总蛋白、自蛋白和前白蛋白较对照组更快恢复到正常水平,与对照组相比差异具有统计学意义[(57.57±9.84)g/L比(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L比(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L比(0.103±0.037)g/L,P=0.000],住院时间也明显缩短[(13.1±1.2)d比(15.2±1.1)d,P=0.041].研究组与对照组的并发症发生率分别为26.7%和31.3%.结论 含橄榄油脂肪乳剂具有很好的耐受性,能够促进术后血浆蛋白的恢复;可能有益于缩短术后住院时间,但对术后并发症发生率无明显影响.