Faintuch J, Machado F K, Freire A N, Reis J R, Machado M, Pinto L P, Ramos S M, Loebens M, Jovchelevich V, Pinotti H W
Nutrition Group, Hospital das Clínicas, São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1996 Mar-Apr;51(2):60-4.
Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.
含脂质的全胃肠外营养是重症创伤患者广泛接受的代谢支持方式。在不超过剂量限制时，脂质输注不耐受情况并不常见，并且现代脂肪乳剂很少记录到血液学紊乱。在6名因创伤性损伤入院的成年患者静脉营养过程中，4天至5周后出现了伴有或不伴有白细胞减少的嗜酸性粒细胞增多。记录了该人群的主要临床事件和血液学紊乱情况。并发症发生时患者并非总是存在脓毒症，对于那些确实需要使用抗生素和其他药物的患者，整个病程中用药处方保持不变。停用含脂质的营养方案后，血液学指标恢复正常，提示是急性或亚急性过敏反应所致。两次出现皮疹进一步支持了这一假设，在两名出现可逆性急性白细胞减少的患者中，噬血细胞现象的可能性值得考虑。结论是，创伤患者静脉输注脂质期间可能出现血细胞异常，但往往对停用含脂质的营养处方有反应。
