Fletcher J P, Mudie J M
Department of Surgery, University of Sydney, Westmead, New South Wales, Australia.
Aust N Z J Surg. 1989 Mar;59(3):223-8. doi: 10.1111/j.1445-2197.1989.tb01505.x.
During a 2 year period, 229 non-intensive care patients received total parenteral nutrition (TPN) for a mean of 23.2 days. Nutritional parameters of weight, triceps skin-fold thickness (TSF), mid-arm muscle circumference (MAMC), total lymphocyte count (TLC), serum albumin and serum transferrin were measured prior to commencement of TPN and then at weekly intervals. All parameters showed an upward trend during the period of TPN. This was small and not statistically significant for weight, TSF, MAMC and albumin; the trends were greater and statistically significant for transferrin (P = 0.001) and TLC (P = 0.002). In contrast, in the 14.4% of patients who died, albumin, transferrin and TLC all fell. Patients who died had a significantly lower initial albumin (P = 0.05), transferrin (P = 0.04) and TLC (P = 0.04). The last values obtained in patients who died were very significantly lower for albumin (P less than 0.001), transferrin (P less than 0.001) and TLC (P = 0.003). Single-lumen tunnelled subclavian catheters had a significantly lower incidence of catheter sepsis (4.8%) compared with double-lumen (17.4%) and triple-lumen (13.7%) catheters (P = 0.01). There was also a greater incidence of mechanical and thrombotic complications with multiple-lumen catheters compared with single-lumen catheters (P = 0.02). This study shows that the nutritional indices albumin, transferrin and TLC have prognostic significance. Single-lumen rather than multiple-lumen catheters should be used for administration of TPN whenever possible.
在为期2年的时间里，229名非重症监护患者接受了全胃肠外营养（TPN），平均时长为23.2天。在开始TPN之前以及之后每周测量体重、肱三头肌皮褶厚度（TSF）、上臂中部肌肉周长（MAMC）、总淋巴细胞计数（TLC）、血清白蛋白和血清转铁蛋白等营养参数。在TPN期间，所有参数均呈上升趋势。体重、TSF、MAMC和白蛋白的上升幅度较小且无统计学意义；转铁蛋白（P = 0.001）和TLC（P = 0.002）的上升趋势更明显且具有统计学意义。相比之下，在14.4%死亡的患者中，白蛋白、转铁蛋白和TLC均下降。死亡患者的初始白蛋白（P = 0.05）、转铁蛋白（P = 0.04）和TLC（P = 0.04）显著更低。死亡患者最后测得的白蛋白（P < 0.001）、转铁蛋白（P < 0.001）和TLC（P = 0.003）值非常显著地更低。单腔隧道式锁骨下导管的导管败血症发生率（4.8%）显著低于双腔（17.4%）和三腔（13.7%）导管（P = 0.01）。与单腔导管相比，多腔导管的机械和血栓并发症发生率也更高（P = 0.02）。本研究表明，营养指标白蛋白、转铁蛋白和TLC具有预后意义。只要有可能，应使用单腔而非多腔导管进行TPN给药。
