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多种油脂肪乳在胃肠外科重症患者术后肠外营养中的应用
目的：探讨术后应用多种油脂肪乳（SMOF）的肠外营养治疗对胃肠外科重症患者预后的影响。方法将72例胃肠外科重症患者按照前瞻、随机、对照原则分为SMOF组及对照组，分别给予含SMOF及中、长链脂肪乳的等热量的肠外营养支持，于使用前及使用后第4、9天分别检测丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、白蛋白（ALB）、C反应蛋白（CRP）、白介素6（IL-6）及外周血内毒素水平，并统计两组患者的重症监护病房（ICU）住院时间、抗菌素使用时间及术后并发症发生率。计量数据采用独立样本t检验，计数数据采用χ2检验。结果术后第4天，SMOF组CRP、TL-6低于对照组（P&0.05）；术后第9天，SMOF组ALT、TBIL、CRP、TL-6低于对照组（P&0.05），术后两组患者ALB及外周血内毒素水平无显著性差异。术后ICU入住时间、抗菌素使用时间，SMOF组低于对照组（P&0.05），术后感染性并发症，SMOF组低于对照组，但二者之间无统计学意义（χ2=1.047，P&0.05）。结论胃肠外科重症患者术后应用添加SMOF的肠外营养能够有效减少炎症介质释放、保护重要脏器功能，减少术后并发症，改善患者的预后。
Abstract：
Objective To investigate the effect of parenteral nutrition support with a lipid emulsion formulation (containing soybean oil, medium chain triglycerides, olive oil, and fish oil [SMOF]) in intensive care patients following major gastrointestinal surgeries. Methods According to a randomized, prospective and case-controlled design, 72 intensive care patients following major gastrointestinal surgeries between January and December, 2014 were randomized equally into SMOF group and control group to receive parenteral nutrition support with SMOF and medium or long chain lipid emulsion, respectively. Before and at 4 and 9 days after commencement of parenteral nutrition support, the patients were examined for alanine aminotransferase (ALT), total bilirubin (TBIL), albumin (propagated), C-reactive protein (CRP), interleukin 6 (IL-6), and endotoxin levels. The patients' average length of stay in intensive care unit (ICU), the days of using antibiotics, and the incidence rate of postoperative complication were recorded. Results On day 4 postoperatively, the levels of CRP and IL-6 were significantly lower in SMOF group than in the control group (t=2.669 and 2.676, P&0.05), and on day 9, the patients in SMOF group showed significantly lower levels of ALT, TBIL, CRP and IL-6 (t=2.487, 3.497, 3.762, 2.180,P&0.05) than the control group, but ALB and endotoxin levels remained comparable between the two groups. The average length of stay in ICU and the days of using antibiotics were significantly shorter in SMOF group than in the control group (t=2.94 and 2.17,P&0.05);SMOF group showed a lower incidence of postoperative infections than the control group, but the difference was not statistically significant (χ2=1.047, P&0.05). Conclusion For intensive care patients following major gastrointestinal surgeries, postoperative parenteral nutrition support with SMOF can effectively reduce the release of inflammatory mediators, protect important visceral functions, reduce postoperative complications, shorten the length of ICU stay, and improve the prognosis of the patients.
LI Liangqing
作者单位：
福建医科大学附属第一医院胃肠外科一区,福建 福州,350005
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国家临床重点专科项目；福建省中青年教师教育科研项目
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