Nakago R, Tsuge H, Harano M, Kawata N, Takakura N, Tanaka N
First Department of Surgery, Okayama University Medical School, Japan.
J Med. 2000;31(1-2):31-44.
To prevent the development of liver failure after simultaneous massive resection of the liver and pancreas, we examined whether fat emulsion could be used as an energy source during postoperative transfusion. Using rats, the following four groups were prepared: the simple laparotomy group (S group), 68% hepatectomy group (H group), 90% pancreatectomy group (P group) and 68% hepatectomy + 90% pancreatectomy group (HP group). A constant total calorie level and transfusion dose were used. Three kinds of transfusions with different glucose-to-fat emulsion caloric ratios, that is: 75% fat emulsion (of the total calorie level) + 25% glucose (75L), 50% fat emulsion + 50% glucose (50L) and 25% fat emulsion + 75% glucose + 1 unit/5 g glucose of insulin (25L), were continuously administered for 48 hours, and the effects of these transfusions on the survival rate and liver were examined. After 75L administration, survival rates in the H group and HP group were significantly lower than those in the S group and P group. After administration of 50L, survival rates did not significantly differ among the four groups. After 25L administration, the survival rate in the HP group was significantly lower than that in other groups. In the HP group, the survival rate after 50L administration was the highest. However, necrosis was observed in a portion of the hepatic lobule, while the blood aspartate aminotransferase (AST) level was increased. After 25L administration, hepatocellular mitochondrial swelling and degeneration were noted in the HP group; furthermore, the blood total protein level was decreased. These results showed that the post-operative administration of fat emulsion at a percentage of 50% of the total calorie level caused partial hepatocellular necrosis in the HP group, but improved the survival rate.
为预防肝脏和胰腺同时进行大规模切除术后发生肝衰竭，我们研究了脂肪乳剂在术后输血期间是否可作为能量来源。使用大鼠制备了以下四组：单纯剖腹手术组（S组）、68%肝切除组（H组）、90%胰腺切除组（P组）和68%肝切除+90%胰腺切除组（HP组）。采用恒定的总热量水平和输血量。连续48小时给予三种不同葡萄糖与脂肪乳剂热量比的输血方案，即：占总热量水平75%的脂肪乳剂+25%葡萄糖（75L）、50%脂肪乳剂+50%葡萄糖（50L）和25%脂肪乳剂+75%葡萄糖+每5g葡萄糖1单位胰岛素（25L），并检测这些输血方案对存活率和肝脏的影响。给予75L后，H组和HP组的存活率显著低于S组和P组。给予50L后，四组之间的存活率无显著差异。给予25L后，HP组的存活率显著低于其他组。在HP组中，给予50L后的存活率最高。然而，部分肝小叶出现坏死，同时血液中天冬氨酸转氨酶（AST）水平升高。给予25L后，HP组出现肝细胞线粒体肿胀和变性；此外，血液总蛋白水平降低。这些结果表明，术后给予占总热量水平50%的脂肪乳剂导致HP组部分肝细胞坏死，但提高了存活率。
