结构脂肪乳剂与物理混合中长链脂肪乳剂在危重症患者中的临床应用

目的比较结构脂肪乳和物理混合的中／长链脂肪乳剂在危重症患者营养支持治疗中的疗效。方法61例短期内不能耐受肠内营养和存在肠内营养禁忌的危重症患者分为结构脂肪乳（STG）组和中／长链脂肪乳（MCT／LCT）组，给予肠外营养支持，观察血浆蛋白、脂质代谢、血糖变化等。结果①胃肠外营养（PN）支持治疗5d后，STG组获得正氮平衡，其结果与MCT／LCT组比较，差异有显著性意义（P〈0．05），STG组前白蛋白的增高可更好地促进蛋白合成。②sTG组患者予肠外营养支持5d后与输注前比较其甘油三酯和胆固醇水平差异无显著性（P〉0．05）。但MCT／LCT组血脂水平变化有显著性差异（P〈0．05）。③对血糖影响差异无显著性（P〉0．05）。结论不耐受肠内营养和存在肠内营养禁忌的危重症患者应用结构脂肪乳进行肠外营养是安全和有效的，在改善氮平衡，促进蛋白质合成方面优于物理混合的中，长链脂肪乳剂，且对血脂影响较小。

Clinical application of the structured triglyceride and physical mixed MCT/LCT in critically ill patients

Objective To compare the efficacy of nutritional support of structured triglyceride （STG）and physical mixed MCTFLCT in critically ill patients. Methods 61 patients who were intolerant of enteral nutrition in short - term were randomly allocated into STG group （n=33） and MCT FLCT group （n=28）, Plasma protein,blood glucose and indexes of lipid metabolism were analyzed. Results STG group achieved a positive nitrogen balanced easier than MCT/LCT group （P〈 0.05）, STG group had a higher level of prealbumin what promoted protein synthesis. The difference between STG group and MCT/LCT group of triglye- eride and cholesterol level wasn＇t significant（P〉.05）.The difference between STG group and MCT/LCT group of blood glu- cose wasn＇t significant（P〉0.05 ）. Conclusion It was safe and effective to choose STG to the patients who are intolerant of en- teral nutrition. STG can easier achieve a positive nitrogen balance, and had less impact on blood lipids.