Smirniotis V, Kostopanagiotou G, Vassiliou J, Arkadopoulos N, Vassiliou P, Datsis A, Kourias E
2nd Department of Surgery, University of Athens Medical School, Areteion Hospital, Greece.
Intensive Care Med. 1998 Oct;24(10):1029-33. doi: 10.1007/s001340050711.
To compare pulmonary haemodynamic and gas exchange alterations in septic patients with ARDS receiving long-chain triglycerides (LCT) versus medium-chain triglycerides (MCT).
Prospective, randomised, clinical study.
Surgical ICU patients in a University Hospital.
Twenty-one septic patients with ARDS were randomly assigned to receive 50 % of their non-protein caloric requirements as either 20 % LCT (group 1, n = 10) or 20% 1:1 mixture of LCT/MCT (group 2, n = 11).
Intravenous infusion of LCT and LCT/MCT combinations at a rate of 12 g x h(-1).
The LCT infusion was associated with an increase of pulmonary venous admixture (Qva/Qt) from 24 % +/- 5 % to 37 % +/- 6 %, an increase of mean pulmonary artery pressure (MPAP) from 25 +/- 5 to 33 +/- 4 mmHg and decrease of PaO2/FIO2 from 240 +/- 30 to 180 +/- 35. LCT/MCT administration was only associated with an elevation of oxygen consumption (VO2) from 329 +/- 14 to 396 +/- 12 ml/ min. During lipid infusion group 1 patients presented higher Qva/Qt (37% +/- 6% vs 25% +/- 4%), MPAP (33 +/- 4 vs 27 +/- 3 mmHg) and VO2 (359 +/- 11 vs 396 +/- 12 ml/min) and lower PaO2/FIO2 (180 +/- 35 vs 235 +/- 30) values compared to group 2.
In conclusion, we have shown that, in septic patients with respiratory failure, LCT administration was associated with more significant changes of Qva/Qt, MPAP and PaO2/FIO2 compared to infusion of an LCT/MCT 1:1 emulsion. Clinically, these transient alterations might cause serious problems in patients with marginal arterial oxygenation and cardio-respiratory impairment.
比较接受长链甘油三酯（LCT）与中链甘油三酯（MCT）的急性呼吸窘迫综合征（ARDS）脓毒症患者的肺血流动力学和气体交换改变。
前瞻性、随机、临床研究。
大学医院的外科重症监护病房患者。
21例ARDS脓毒症患者被随机分配，接受其非蛋白热量需求的50%，以20%LCT（第1组，n = 10）或20%LCT/MCT 1:1混合物（第2组，n = 11）的形式给予。
以12 g×h⁻¹的速率静脉输注LCT和LCT/MCT组合。
输注LCT与肺静脉混合血（Qva/Qt）从24%±5%增加到37%±6%、平均肺动脉压（MPAP）从25±5升高到33±4 mmHg以及PaO₂/FIO₂从240±30降低到180±35相关。给予LCT/MCT仅与氧耗量（VO₂）从329±14升高到396±12 ml/min相关。在脂质输注期间，与第2组相比，第1组患者的Qva/Qt（37%±6%对25%±4%）、MPAP（33±4对27±3 mmHg）和VO₂（359±11对396±12 ml/min）更高，而PaO₂/FIO₂（180±35对235±30）更低。
总之，我们已表明，在呼吸衰竭的脓毒症患者中，与输注LCT/MCT 1:1乳剂相比，给予LCT与Qva/Qt、MPAP和PaO₂/FIO₂更显著的变化相关。临床上，这些短暂改变可能在动脉氧合临界和心肺功能受损的患者中引起严重问题。
