Chambrier C, Leclercq M, Saudin F, Vignal B, Bryssine S, Guillaumont M, Bouletreau P
Unité de Nutrition Artificielle, Hotel Dieu, Lyon, France.
JPEN J Parenter Enteral Nutr. 1998 Mar-Apr;22(2):87-90. doi: 10.1177/014860719802200287.
I.v. lipid emulsions contain vitamin K in substantial quantities and in 1989, we therfore stopped supplying vitamin K1 to patients receiving home parenteral nutrition (HPN).
Nine patients (group I) receiving HPN before 1989 (10 mg i.v. vitamin K1 supplementation weekly until 1989, which was discontinued thereafter) and six patients with an initial low plasma vitamin K1 concentration (related to their malabsorption) (group II) receiving HPN after 1989 were studied. Prothrombin time (PT), plasma vitamin K1 concentration, and vitamin K1, content in lipid emulsions were measured throughout the period of HPN.
All lipid emulsions, except for Eurolip 20% and Clinoleic 20% (Baxter SA, Maurepas, France) contained vitamin K1, with concentration ranges from 179 +/- 39 to 353 +/- 78 ng/L. Group I patients had an initial high plasma vitamin K1 concentration due to the vitamin K1 supplementation. After this supplementation was discontinued, plasma vitamin K1 decreased and remained in normal ranges with a normal PT. Throughout the HPN period after 1989, patients received 255 +/- 104 micrograms of vitamin K1 weekly through lipid emulsions. The PT and plasma vitamin K1 concentrations in group II patients were restored by lipid emulsions, which contained 418 +/- 143 micrograms/wk of vitamin K1.
In patients receiving i.v. lipids (except for Eurolip and Clinoleic), a normal vitamin K1 status can be maintained during long-term HPN without vitamin K1 supplementation. However, vitamin K supplementation cannot be abandoned until the vitamin K content of emulsions is standardized by manufacturers. A weekly supply of 250 to 400 micrograms of vitamin K1 is enough to maintain and even restore a normal vitamin K1 status in HPN.
静脉注射脂质乳剂含有大量维生素K，因此在1989年，我们停止向接受家庭肠外营养（HPN）的患者供应维生素K1。
对1989年前接受HPN的9例患者（第一组）（1989年前每周静脉补充10 mg维生素K1，此后停用）和1989年后接受HPN的6例初始血浆维生素K1浓度较低（与吸收不良有关）的患者（第二组）进行研究。在整个HPN期间测量凝血酶原时间（PT）、血浆维生素K1浓度以及脂质乳剂中的维生素K1含量。
除了欧力匹20%和克列诺利克20%（法国莫勒帕斯百特公司）外，所有脂质乳剂均含有维生素K1，浓度范围为179±39至353±78 ng/L。第一组患者由于补充维生素K1，初始血浆维生素K1浓度较高。停用该补充剂后，血浆维生素K1下降并保持在正常范围内，PT也正常。在1989年后的整个HPN期间，患者通过脂质乳剂每周接受255±104μg维生素K1。脂质乳剂使第二组患者的PT和血浆维生素K1浓度恢复正常，脂质乳剂中维生素K1含量为418±143μg/周。
在接受静脉注射脂质（欧力匹和克列诺利克除外）的患者中，长期HPN期间无需补充维生素K1即可维持正常的维生素K1状态。然而，在制造商将乳剂的维生素K含量标准化之前，不能放弃维生素K补充。每周供应250至400μg维生素K1足以维持甚至恢复HPN患者正常的维生素K1状态。
