Ball M J
Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
Intensive Care Med. 1993;19(2):89-95. doi: 10.1007/BF01708368.
The study investigated the use of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) in critically ill patients, and compared the effects with those of a conventional long chain triglyceride (LCT) preparation.
Patients received a parenteral nutrition regime including either 500 ml 20% Lipofundin MCT/LCT (1/1) per day, or 500 ml 20% Lipofundin S (LCT) infused over 8 h each evening.
The patients were receiving treatment, including assisted ventilation, in the Intensive Care Unit of a large teaching hospital. All patients on this unit for at least 3 days and who were likely to receive parenteral nutrition for at least a week were considered, unless they had severe renal or liver disease, or trauma/major surgery in the previous 3 days. Because ICU patients are a heterogenous group, subjects were randomised within clinical groups to receive either lipid. There were 24 patients entered into the study and the data on 20 matched patients is reported.
Blood specimens were collected pre-TPN, daily at 0800 and after 5 h lipid infusion on days 1 and 6. Urine collections (24 h) were also performed. There were no apparent adverse effects due to the new MCT/LCT emulsion. Plasma ketone and glycerol concentrations were higher during MCT/LCT infusion, but 8 h post infusion plasma levels of ketones, triglycerides, non-esterified fatty acids and glucose were similar. Urinary carnitine excretion was high in all patients and was not significantly different between the groups. Nitrogen balance was less negative in patients receiving MCT/LCT on days 6 and 9.
MCTs are rapidly hydrolysed and oxidised to fatty acids and ketones which can be readily utilised. This study indicates that intravenous lipid emulsion containing MCT are safe in critically ill patients and may have advantages over LCT. The number and range of patients studied was, however, small and larger studies are needed.
本研究调查了含中链甘油三酯（MCT）的静脉脂质乳剂在危重症患者中的应用，并将其效果与传统长链甘油三酯（LCT）制剂进行比较。
患者接受肠外营养方案，每天给予500ml 20% Lipofundin MCT/LCT（1/1），或每晚8小时输注500ml 20% Lipofundin S（LCT）。
患者在一家大型教学医院的重症监护病房接受治疗，包括辅助通气。该病房所有住院至少3天且可能接受至少一周肠外营养的患者均被纳入研究，除非他们患有严重的肾脏或肝脏疾病，或在过去3天内有创伤/大手术史。由于重症监护病房患者群体异质性较大，受试者在临床组内随机接受两种脂质中的一种。共有24名患者进入研究，报告了20名匹配患者的数据。
在全胃肠外营养（TPN）前、第1天和第6天每天08:00以及脂质输注5小时后采集血样。同时进行24小时尿液收集。新的MCT/LCT乳剂未产生明显不良反应。MCT/LCT输注期间血浆酮和甘油浓度较高，但输注后8小时血浆酮、甘油三酯、非酯化脂肪酸和葡萄糖水平相似。所有患者尿中肉碱排泄量均较高，两组间无显著差异。接受MCT/LCT的患者在第6天和第9天的氮平衡负值较小。
MCT可迅速水解并氧化为脂肪酸和酮，易于被利用。本研究表明，含MCT的静脉脂质乳剂在危重症患者中是安全的，可能比LCT更具优势。然而，本研究的患者数量和范围较小，需要开展更大规模的研究。
