中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (06): 480-483.

• 论著 • 上一篇    下一篇

不同脂肪组分营养支持影响肝移植病人蛋白质代谢的临床研究

周    旭，刘    军，杨凤辉，许世峰，公    伟，于光圣，徐延田，卢    俊   

  1. 山东大学附属省立医院器官移植中心肝胆外Ⅱ科，山东济南250021
  • 出版日期:2010-06-01 发布日期:2010-05-25

  • Online:2010-06-01 Published:2010-05-25

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摘要：

目的    比较肝移植病人术后施行肠内、肠外营养对蛋白质代谢的影响，探讨中链脂肪乳（MCT）长链脂肪乳（LCT）改善肝脏移植机体营养状态的作用机制。方法    将肝脏移植术后进行营养支持的86例病人随机分为4组（F组、N组、K组、C组），分组检测肝脏移植病人术前1d、术后1、4、7、10d蛋白质代谢情况。结果    肝移植后机体蛋白分解增加，血清蛋白水平下降；F、N组病人血清转铁蛋白、前白蛋白水平明显高于K、C组；F、N组尿-3甲基组氨酸排出明显低于K、C组；在施行肠内营养的两组病人中，F组病人血清转铁蛋白、前白蛋白水平明显高于N组，F组病人尿-3甲基组氨酸排出量明显低于N组；术后第3天起与C组相比，F、N、K组病人每日氮平衡和累计氮平衡差异均有统计学意义（P＜0.05或P＜0.01）。 结论    含MCT/LCT的肠内营养较只含LCT的营养支持能更有效地减轻肝脏移植病人术后机体蛋白质分解，加快机体从分解代谢向合成代谢的转变，从而改善肝脏移植术后病人的营养状况。

关键词: 肝脏移植, 肠内营养, 肠外营养, 中链脂肪

Abstract:

Clinical research of effects of nutrition support containing differential fatty acids ingredient on improving protein catabolism of liver transplantation patients        ZHOU Xü, LIU Jun, YANG Feng-hui, et al. Center of Organ Transplantation, Provincial Hospital Affiliated to Shandong University, Jinan 250021,China
Corresponding author: LIU Jun, E-mail:zhouxu2008@sina.com
Abstract    Objective    To compare the difference of effects between enteral nutrition and parenteral nutrition formula containing either MCT/LCT or LCT only on protein metabolism of liver transplantation(LTP) patients and determine the mechanism of MCT/LCT improving nutritional status of LTP patients. Methods    A random controlled clinical trail containing 86 cases of liver transplantation was conducted and all the cases were divided into 4 groups.  The several parameters were observed before liver transplantation 1day and after liver transplantation 1, 4, 7 and 10 days, such as serum concentrations of transferrin and prealbumin. Results    The results showed that the patients of F, N group had an increased blood concentration of transferrin, prealbumin than those of the patients of K, C group( P<0.05 or P<0.01). The above two parameters were markedly higher in group F than in group N as same as group K vs group C(P<0.05 or P<0.01). Excretion of nitrogen and 3-methylhistidine in urine was also markedly reduced in patients fed with nutrients containing MCT/LCT compared with LCT(P<0.05 or P<0.01) . Nitrogen balance was better in group F than that in N and K group. Conclusion    An enteral compound diet containing MCT/LCT can reduce decomposition of the body proteins, enhance the level of serum albumin, and improve the status of protein metabolism of patients after liver transplantation more effectively.

Key words: liver transplantation, enteral nutrition, parenteral nutrition, medium-chain triglyceride