还原型谷胱甘肽联系结构脂肪乳在预防肠外营养相关性肝损害中的应用汇编.doc

还原型谷胱甘肽联合结构脂肪乳在预防肠外营养相关性肝损害中的应用 王宏星1 高秋芳2 （1 南通市妇幼保健院 消化内科 江苏南通226000；2无锡市第三人民医院 临床药学科 江苏无锡 214041） 【摘要】目的 研究还原型谷胱甘肽联合结构脂肪乳对肠外营养相关性肝损害的预防和保护作用。方法 将64例经过筛选符合要求且预计需较长期全胃肠外营养的普外科住院患者按照随机数字表法随机分为对照组(n=30)和研究组(n=34)，两组均根据等氮等热量原则给予入组后全胃肠外营养治疗，非蛋白热卡25-30kcal/kg.d，氮热比维持在1:125-150，糖脂比维持在50%-70%：30%-50%，对照组采用20%中/长链脂肪乳，研究组采用20%结构脂肪乳联合还原型谷胱甘肽（1200mg/天），全肠外营养支持持续15天以上，并于全胃肠外营养后15天比较两组患者血脂、肝功能和营养相关性肝损害发生率等指标，进行统计学分析。结果 第15天两组比较谷丙转氨酶、谷草转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、血清总胆红素、直接胆红素、血清甘油三酯及营养相关性肝损害发生率差异均有统计学意义，研究组优于对照组，P0.05。结论 在长期全肠外营养支持中，预防营养相关性肝损害的发生是一项十分重要的工作；还原型谷胱甘肽联合结构脂肪乳结构脂肪乳能很好地降低长期全肠外营养支持患者营养相关性肝损害的发生率。 【关键词】营养支持；全胃肠外营养；营养相关性肝损害；结构脂肪乳；还原型谷胱甘肽 The application of glutathione combined with structured triglyceride to prevent parenteral nutrition-associated liver disease (PNALD) [Abstract]Objective To research the preventive and protective effects of glutathione combined with structured triglyceride on parenteral nutrition-associated liver disease (PNALD) in long time total parenteral nutrition (TPN). Methods 64 hospitalized patients who fit the demands were radomnly divided into two groups(the control group, n=30, the study group, n=34). Both groups were treated with equal calorie and equal nitrogen parenteral nutrition, energy supported without protein was 25-30kcal/kg.d, the ratio of nitrogen versus calorie was 1g:125-150kcal，the ratio of thecalorie carbohydrate provided versus fat provided was 50%-70%：30%-50%. Fat in control group was supported by the 20% medium chain/long chain triglycerides. While fat in study group was supported by the 20% structured triglyceride and glutathione(1200mg per day).This work must be carried more over 15 days. The blood lipids, liver function and the incidence rate of PNALD. Take a statistic analysis of all over the indexes. Results There was a significant difference between the two groups among the indexes of alanine aminotransferase (ALT)，Aspartate amine transferase (AST), alkaline phosphatase(ALP), γ-glutamyl transpeptidase (γ-GT), serum total bilirub