Burstyne M, Jensen G L
Department of Consumer Science and Education, University of Memphis, Memphis, Tennessee, USA.
Nutrition. 2000 Nov-Dec;16(11-12):1090-2. doi: 10.1016/s0899-9007(00)00439-1.
The pathogenesis of total parenteral nutrition (TPN)-induced liver cholestasis is poorly understood. Cholestasis generally occurs late in TPN therapy in association with elevated serum alkaline phosphatase and total bilirubin concentrations. Such factors as preexisting medical conditions, excessive nutrient infusion, amino-acid deficiency, absence of enteral stimulation, protracted duration of therapy, continuous infusion schedule, and hypoalbuminemia have all been suggested as possible etiologies. Various treatments have been proposed for the correction of TPN-induced cholestasis including administration of bile salt and antimicrobial therapies. To avoid potential hepatic complications associated with TPN, certain preventive measures can be considered. Administration of energy substrates should not be excessive. A mixed-fuel system that includes lipids should be implemented. TPN should be cycled if it will be used long term, and initiation of enteral nutrition should begin as soon as possible.
全胃肠外营养（TPN）所致肝内胆汁淤积的发病机制尚不清楚。胆汁淤积通常发生在TPN治疗后期，伴有血清碱性磷酸酶和总胆红素浓度升高。诸如既往存在的疾病状况、营养物质输注过量、氨基酸缺乏、缺乏肠内刺激、治疗时间延长、持续输注方案以及低白蛋白血症等因素均被认为可能是病因。针对TPN所致胆汁淤积的纠正，已提出了各种治疗方法，包括给予胆盐和抗菌治疗。为避免与TPN相关的潜在肝脏并发症，可考虑采取某些预防措施。能量底物的给予不应过量。应采用包括脂质的混合燃料系统。如果长期使用TPN，应采用循环输注方式，并且应尽快开始肠内营养。
