Eckart J, Neeser G, Adolph M, Hailer S, Wolfram G
Institut für Anästhesiologie, Krankenhauszweckverband Augsburg.
Infusionsther Klin Ernahr. 1987 Sep;14 Suppl 3:38-49.
In an effort to supply energy carriers with a high utilization rate specifically in parenteral nutrition during postaggression metabolism, fat emulsions were developed containing long- and medium-chained triglycerides in a 1:1 ratio. The special advantage of the medium-chained fatty acids is, among other things, their low rate of accumulation and high oxidation rate in the organism. Using a graduated schedule, intensive-care patients who were being parenterally fed exclusively were administered either an MCT/LCT mixture or an LCT emulsion alone as a bolus injection and later continuously. Among other things, the behavior of the triglyceride concentrate and the individual fatty acids in serum and of individual lipid fractions, as well as the effect on various parameters of carbohydrate and fat metabolism, were measured. In addition, the oxidation rate of an MCT/LCT emulsion labelled with 13C was measured. The results of the comparative lipid studies were compared. The expected result-that the oxidation rate of medium-chained triglycerides exceeds that of long-chained triglycerides-was confirmed. It was surprising that the median oxidation rate with a continuous fat supply within a complete nutrition program was only 32 +/- 6.8%. Why some patients showed higher triglyceride levels with the MCT/LCT emulsion than with the supply of LCT alone is still unclear. It remains to be investigated whether the rapid splitting of medium-chained triglycerides leads to a temporary loss of activity of the lipoprotein lipase accompanied by a rise in triglycerides in serum. More research will be necessary before we know what role MCT/LCT emulsions will play in future. Such an emulsion would possibly be suitable in severely injured patients, whereby the MCT portion could preferentially supply the organism with energy carriers and the long-chained triglycerides structural components.
为了在创伤后代谢期间，特别是在肠外营养中为能量载体提供高利用率，人们研发出了长链和中链甘油三酯比例为1:1的脂肪乳剂。中链脂肪酸的特殊优势包括在生物体内积累率低和氧化率高。采用分级给药方案，对仅接受肠外营养的重症监护患者，以大剂量注射的方式单独给予中/长链甘油三酯混合物（MCT/LCT）或长链甘油三酯乳剂（LCT），随后持续给药。除其他方面外，还测量了血清中甘油三酯浓缩物和各脂肪酸以及各脂质组分的情况，以及对碳水化合物和脂肪代谢各项参数的影响。此外，还测量了用13C标记的MCT/LCT乳剂的氧化率。对脂质对比研究的结果进行了比较。预期结果——中链甘油三酯的氧化率超过长链甘油三酯的氧化率——得到了证实。令人惊讶的是，在完整营养方案中持续供应脂肪时，中链甘油三酯的中位氧化率仅为32±6.8%。为何一些患者使用MCT/LCT乳剂时甘油三酯水平高于单独供应LCT时仍不清楚。中链甘油三酯的快速分解是否会导致脂蛋白脂肪酶暂时失活并伴随血清甘油三酯升高，仍有待研究。在我们了解MCT/LCT乳剂在未来将发挥何种作用之前，还需要进行更多研究。这样的乳剂可能适用于重伤患者，其中MCT部分可为机体优先提供能量载体，长链甘油三酯提供结构成分。
