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目的探索重症胰腺炎病人对静脉输注脂肪乳剂的耐受性。方法33例重症胰腺炎病人,其中27例基础血甘油三酯(TG)值正常者随机分成A、B、C三组,6例基础血TG值高于正常者列为D组。各组均给予肠外营养:A组以葡萄糖单能源供能,热卡量为800~1000kcal/d;在提供热卡与氮源相同的条件下,B、C组均以双能源供能,其糖脂热卡比分别为6∶4及5∶5;D组肠外营养配方根据血TG、血糖测定值而定。以脂肪乳剂廓清试验观察对输注脂肪乳剂的耐受性。结果B、C组每日输注脂肪65.0~80.0g均能耐受;D组有5例基础血TG值>4.06mmol/L,且空腹血清呈乳状,脂肪乳剂廓清试验阳性,1例基础血TG值为3.14mmol/L,空腹血清不呈乳状,脂肪乳剂廓清试验弱阳性。结论①基础血TG值正常的胰腺炎病人,每日输注占总热卡40%~50%的脂肪乳剂均能耐受;②伴高TG血症的胰腺炎病人,应根据基础血TG值增高的程度及是否存在空腹乳状血清,来判断应用、慎用或不用肪脂乳剂。
Objective To explore the tolerance of intravenous fat emulsion in patients with severe acute pancreatitis. Methods Totally 33 patients with severe acute pancreatitis were randomly divided into three groups (A, B and C). 27 patients with normal basal levels of triglyceride (TG) were considered as D group. All groups were given parenteral nutrition: Group A was fed with a single energy source of glucose, with a caloric intake of 800-1000 kcal / d; while both B and C were supplied with dual energy sources under the same heat card and nitrogen source conditions, The glycolipid heat card ratio were 6: 4 and 5: 5; D group parenteral nutrition formula based on blood TG, blood glucose determination may be. The lipid emulsion clearance test was used to observe the tolerance to the infusion of fat emulsion. Results In group B and group C, 65.0-80.0 g of fat per day could be tolerated. In group D, there were 5 cases with basal serum TG> 4.06 mmol / L, and fasting serum was milky, and fat emulsion clearance test was positive. One case of basal blood TG value of 3.14mmol / L, fasting serum is not milky, fat emulsion clearance test weakly positive. Conclusions ① In patients with pancreatitis with normal serum TG value, daily fat emulsion containing 40% ~ 50% of total calories can be tolerated. ② Patients with pancreatic inflammation with high TG serum should be treated according to the basal blood TG value Increase the degree and the presence of fasting serum, to determine the application, with or without fat emulsion.