加用1,6-二磷酸果糖的全肠外营养对感染动物及危重病人的支持效果

摘要

目的比较加用1,6-二磷酸果糖(FDP)的全肠外营养及常规全肠外营养对危重应激机体的营养支持效果.方法将13条已经造成感染模型的犬分成两组.第一组为TPN组(n=6),输入常规TPN液.第二组为加用1,6-二磷酸果糖的实验组(TPN+FDP组,n=7),在常规TPN液中加入每天每千克体重1克FDP钠盐.在此基础上,对一组重症应激病人应用1周TPN+FDP及常规TPN作比较研究.结果在TPN+FDP组动物,经24h,48h支持后血浆ATP水平明显升高(P＜0.01),而在常规TPN组则变化不明显,两者相差也有显著意义.此外,肌肉中ATP及磷酸肌酸含量在TPN+FDP组也有显著升高.免疫组化技术发现在TPN+FDP组动物的骨骼肌内有大量细胞色素氧化酶颗粒.在临床病人的对比研究中,接受TPN+FDP的病人血中ATP升高、尿3-甲基组氨酸排出量下降,正氮平衡明显加强.结论 TPN中加入FDP对感染动物及危重应激病人有较好的营养支持效果.%Objective To investigate the roles of fructose-1,6-diphosphate(FDP)-added total parenteral nutrition rn(TPN)in septic animals and stressed patients.Methods Thirteen adult dogs were randomly assigned to one of two study groups 6 hours after the induction of severe intra-abdominal infection.Group TPN(n =6)received 70 kcal· kg-1· d-1 of nonprotein calorie(NPC)and 0.56 g· kg-1· d-1 of nitrogen.1 g/kg of FDP was also infused to the animals in group TPN + FDP(n = 7)everyday.In the clinical study,the control group received routine TPN,while the study group(n = 16)was treated with TPN plus FDP(5 g,two times a day)for 7 days.Results In dogs with TPN support,plasma ATP levels were not changed significantly,while the value in the TPN + FDP group increased significantly from 0.18 μmol/L to 0.46 μmol/L at 24 h and 0.51 μmol/L at 48 h(P ＜ 0.01).Muscular ATP increased markedly in the TPN + FDP group.Muscular creatine phosphate alues were not significantly changed in the TPN group,but the values increased in the TPN + FDP group from 4.06 μmol/g·wt at the beginning to 4.93 μmol/g· wt at 24 h and 5.60 μmol/g·wt at 48 h(P ＜ 0.05),with a cytochrome oxidase increase in immunohistochemistry stain.In the clinical study,plasma ATP levels increased and urinary 3-methylhistidine production significantly decreased with an improved value for positive accumulative nitrogen balance in the FDP-infused group.Conclusion Our results suggest that total parenteral nutrition support with the supplement of fructose-1,6-diphosphate has a positive role in body energy production and protein metabolism in septic animals and stressed patients.