高脂低乳糖肠营养的代谢影响 肠营养
Andrew Adorno1, Michael Ghio1, John Tyler Simpson1
1Department of Surgery, Tulane Medical Center, New Orleans, LA, 70112, USA.
Clinical nutrition ESPEN
|September 22, 2023
概括
用更高的混合脂质和更低的乳糖进行腹腔营养,改善了患者的治疗结果,减少了高血糖和炎症标志物. 这表明调整PN配方中的脂质和乳糖含量的潜在好处.
科学领域:
- 临床营养学 临床营养学
- 代谢支持 代谢支持
- 密集护理医学 密集护理医学
背景情况:
- 使用100%大豆油脂和高糖的亲肠道营养 (PN) 可以导致肝功能障碍和高血糖症.
- 混合脂类乳液含有较少的促炎成分,允许使用更高剂量.
- 更高的混合脂质剂量可能使得德克斯特的使用减少,从而减轻不良影响.
研究的目的:
- 为了比较接受高混合脂/低乳糖与低100%大豆油脂/高乳糖的PN患者之间的临床结果.
主要方法:
- 对62名接受PN治疗7天以上的成年患者 (2016-2021) 的回顾性评估.
- 两个组:高脂低乳糖 (HLLD) 与四油脂 (>30%卡路里) 和充足的脂高乳糖 (ALHD) 与100%大豆油脂 (<30%卡路里).
主要成果:
- HLLD组显示高血糖 (>180 mg/dL) 减少了64.1%,胰岛素需求减少.
- HLLD患者的性酸盐酸酶含量降低了52.7%,c-反应蛋白含量降低了42.6%.
- HLLD组的前白蛋白水平高出40.6%,表明营养状况有所改善.
结论:
- 在PN中切换到混合脂质可以减少大豆油摄入量.
- 增加混合脂质剂量,同时减少乳糖 (40-45% kcal脂质,20-30% kcal乳糖) 可能提供临床优势.
- 需要进一步的研究来探索这些调整后的PN配方的好处.
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