比較全靜脈營養輸入中鏈與長鏈三酸甘油酯脂肪乳劑對重症病患術後生化指標及預後之影響

Patients undergoing major surgery may develop malnutrition because of reduce intake result from hypermetabolism and metabolic dysfunction. Artificial nutritional support is necessary for these patients in order to decrease the susceptibility to infection, enhance wound healing and shorten 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 provide essential fatty acids but also the main energy source for such patients. The most common fat emulsions consist of long-chain triglyceride (LCTs), which are abundant in n-6 fatty acids. Because medium-chain triglycerides (MCTs) are rapidly oxidized in the body, a combination of MCT/LCT is thought to be a better fuel source for surgical patients. This is a retrospective study to compare the effects of LCT and MCT/LCT fat emulsions on surgical patients with TPN as the main nutrition support. Thirty-three intensive care unit (ICU) patients were included, including 16 patients in LCT group, 17 in MCT/LCT group. The energy intake and macronutrient distribution were similar in the 2 groups. Plasma albumin, transferrin, triglyceride, bilirubin, alanine aminotransferase, aspartate aminotransferase levels, the white cell count, the Iymphocyte count were collected before and 7 days after TPN in all patients. The results showed no differences in these parameters between the LCT and MCT/LCT groups were observed after different fat emulsions were administered for 7 days. Compared to the levels before TPN, the MCT/LCT group had higher plasma albumin levels 7 days after TPN, whereas that was not found in the LCT group. There were no differences in the duration of the number of days in the ICU or the length of the hospital stay between the 2 groups. These results suggest that compared to the LCT group, the influences of MCT/LCT administration in biochemical parameters and clinical outcome were not obvious in critically ill patients.