Sitzmann J V, Pitt H A, Steinborn P A, Pasha Z R, Sanders R C
Department of Surgery, Johns Hopkins University Medical Institutions, Baltimore, Maryland 21205.
Surg Gynecol Obstet. 1990 Jan;170(1):25-31.
Long term total parenteral nutrition (TPN) induces biliary sludge and formation of gallstones. Cholecystectomy is hazardous in these patients because of the underlying medical problems. Therefore, a randomized, double-blind controlled study was designed to test the hypothesis that daily administration of cholecystokinin-octapeptide (CCK-OP) prevents the formation of biliary sludge in humans receiving long term TPN. Adult patients receiving TPN for more than 21 consecutive days were studied. After randomization of 15 patients, the study was concluded because statistical significance was achieved. Eight patients received saline solution (placebo) intravenously and seven received CCK-OP (50 nanograms per kilogram) intravenously over a ten minute period daily. The groups were similar with respect to age, sex, diagnosis, liver function tests, amylase levels, total TPN time and time of study. All of the patients underwent weekly ultrasound studies. Volume and emptying studies of the gallbladder in response to the study drug were performed after one week. None of the patients receiving CCK-OP had sludge whereas five of eight of the patients receiving placebo had sludge (p less than 0.02). The results of emptying studies showed significant contraction of the gallbladder in those in the CCK-OP group but not in the placebo group. These data suggest that CCK-OP given intravenously daily prevents TPN induced stasis and sludge of the gallbladder. We conclude that CCK-OP should be used as routine prophylaxis against biliary sludge and formation of gallstones in patients receiving long term TPN.
长期全胃肠外营养（TPN）会诱发胆泥形成和胆结石。由于存在基础疾病，胆囊切除术在这些患者中具有危险性。因此，设计了一项随机、双盲对照研究，以检验以下假设：每日给予胆囊收缩素八肽（CCK-OP）可预防接受长期TPN的患者形成胆泥。对连续接受TPN超过21天的成年患者进行了研究。在将15名患者随机分组后，由于达到了统计学显著性，研究结束。8名患者静脉注射生理盐水（安慰剂），7名患者每天在10分钟内静脉注射CCK-OP（每千克50纳克）。两组在年龄、性别、诊断、肝功能检查、淀粉酶水平、总TPN时间和研究时间方面相似。所有患者每周都接受超声检查。一周后，对胆囊进行了针对研究药物的容积和排空研究。接受CCK-OP的患者均未出现胆泥，而接受安慰剂的8名患者中有5名出现了胆泥（p<0.02）。排空研究结果显示，CCK-OP组患者的胆囊有明显收缩，而安慰剂组则没有。这些数据表明，每日静脉给予CCK-OP可预防TPN引起的胆囊淤滞和胆泥形成。我们得出结论，CCK-OP应用于接受长期TPN患者预防胆泥形成和胆结石的常规预防。
