| 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影響進食，而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功能不良，容易造成病人營養不良的發生，並因此延遲傷口癒合時間、增加病人感染的機率、延長呼吸器脫離時間及住院天數；因此臨床上建議對創傷患者宜及早給予適當的營養支持。全靜脈營養(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兩種不同脂肪酸組成的脂肪乳劑，對重症病患其營養狀況及預後的影響。研究設計是以回溯方法篩選2004年8月到2006年12月間於本院一般外科加護病房接受TPN至少七天的患者，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前及七天後各項生化檢驗值及住院天數。研究結果顯示，MCT/LCT組與LCT組血中白蛋白與轉鐵蛋白 TPN前與TPN後兩組間沒有統計上的差異，但MCT/LCT組的白蛋白TPN前後則有統計上的差異。在生化數值方面血中三酸甘油酯(triglyceride)，麩胺酸苯醋酸轉氨基酶(AST)、麩胺酸丙酮酸轉氨基酶(ALT)、膽紅素(Bilirubin)、白血球計數、淋巴球計數、C反應蛋白，於兩組內TPN前後及兩組間的比較上均無統計差異。兩組間的TPN使用天數、術後住加護病房天數及住院天數也沒有統計上顯著的差異。本研究結果顯示使用MCT/LCT組的脂肪乳劑相較於使用LCT組的脂肪乳劑，在對重症病患整體營養狀況及預後的影響並不明顯。
Patients undergo major surgery may develop malnutrition because of reduce intake result from hypermetabolism and metabolic dysfunction. Artificial nutritional support is essential for these patients in order to decrease the susceptibility to infection, enhance wound healing and shorten the ventilation days and 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 provides essential fatty acid but also the main energy source for the patients. The most common fat emulsion is consist of long-chain triglyceride (LCTs), which is abundant in n-6 fatty acids. Because medium-chain triglyceride (MCTs) is rapidly oxidized in the body, a combination of MCT/LCT was thought to be a better fuel source for the surgical patients. This is a retrospective study to compare the effects of LCTs and MCT/LCT fat emulsions in surgical patients with TPN as the main nutrition support. Thirty-three intensive care unit (ICU) patients were included, and there were sixteen patients in LCT group seventeen in MCT/LCT group. The energy intake and macronutrient distribution were similar. Plasma albumin, transferrin, triglyceride, bilirubin, alanine aminotransferase, aspartate aminotransferase, C-reactive protein levels and white cell count, lymphocyte count were collected before and 7 days after TPN in all patients. The results showed that no differences in these parameters between the LCT and MCT/LCT groups were observed after different fat emulsions were administered for 7 days. Compared with the levels before TPN, MCT/LCT group had higher plasma albumin levels 7 days after TPN, whereas it was not with the TPN with LCT. There were no differences in the duration of ICU days and hospital stay between the 2 groups. These results suggest that compared with the LCT group, the influences of MCT/LCT administration in nutritional and biochemical parameters were not obvious in surgical patients. |
