Iovinelli G, Marinangeli F, Ciccone A, Ciccozzi A, Leonardis M, Paladini A, Varrassi G
Department of Anesthesiology, Intensive Care and Pain Management, University of L'Aquila, L'Aquila, Italy.
Minerva Anestesiol. 2007 Jan-Feb;73(1-2):65-76.
The aim of this study was to assess the usefulness of a lipid formulation containing a physical mixture of medium (MCT) and long chain triglycerides (LCT) compared with a long chain triglycerides emulsion in patients affected by chronic obstructive pulmonary disease with acute respiratory failure.
Twenty-four patients requiring mechanical ventilation were randomly selected in 2 groups and received total parenteral nutrition. Twelve patients received a MCT/LCT emulsion (50:50), the others used a 100% LCT emulsion. Nutritional status, metabolic rate, time of ventilatory support and weaning were evaluated.
Both groups showed an improvement of all nutritional parameters evaluated; oxygen uptake, carbon dioxide output and respiratory gas exchange ratio were similar in both groups. The duration of mechanical ventilation was not significantly different; however, the time of weaning in the MCT/LCT group was significantly shorter. The longer weaning time in the LCT group patients could be related to vasoactive intermediates deriving from long chain fatty acids. The T-cell subsets, which were evaluated for both groups, showed a significant decrease of T helper-T suppressor ratio in the LCT group.
MCT/LCT emulsion is an effective lipid supplementation and should be considered the therapy of choice in COPD patients; however, the relationship between lipid emulsions administered and length of weaning requires further investigations.
本研究旨在评估含中链甘油三酯（MCT）和长链甘油三酯（LCT）物理混合物的脂质制剂与长链甘油三酯乳剂相比，对慢性阻塞性肺疾病合并急性呼吸衰竭患者的有效性。
将24例需要机械通气的患者随机分为两组，接受全胃肠外营养。12例患者接受MCT/LCT乳剂（50:50），其余患者使用100%LCT乳剂。评估营养状况、代谢率、通气支持时间和撤机时间。
两组患者所有评估的营养参数均有改善；两组的氧摄取、二氧化碳排出和呼吸气体交换率相似。机械通气时间无显著差异；然而，MCT/LCT组的撤机时间明显更短。LCT组患者撤机时间较长可能与长链脂肪酸衍生的血管活性中间体有关。对两组患者评估的T细胞亚群显示，LCT组辅助性T细胞与抑制性T细胞的比例显著降低。
MCT/LCT乳剂是一种有效的脂质补充剂，应被视为慢性阻塞性肺疾病患者的首选治疗方法；然而，给予脂质乳剂与撤机时间之间的关系需要进一步研究。
