重症胰腺炎病人对静脉输注脂肪乳剂耐受性的临床研究周亚魁史海安何跃明贺银成黄昌洲杨先勇曹军王正元【摘要】目的探索重症胰腺炎病人对静脉输注脂肪乳剂的耐受性。方法33例重症胰腺炎病人，其中27例基础血甘油三酯(TG)值正常者随机分成A、B、C三组，6例基础血TG值高于正常者列为D组。各组均给予肠外营养：A组以葡萄糖单能源供能，热卡量为800～1000kcal/d；在提供热卡与氮源相同的条件下，B、C组均以双能源供能，其糖脂热卡比分别为6∶4及5∶5；D组肠外营养配方根据血TG、血糖测定值而定。以脂肪乳剂廓清试验观察对输注脂肪乳剂的耐受性。结果B、C组每日输注脂肪65.0～80.0g均能耐受；D组有5例基础血TG值>4.06mmol/L，且空腹血清呈乳状，脂肪乳剂廓清试验阳性，1例基础血TG值为3.14mmol/L，空腹血清不呈乳状，脂肪乳剂廓清试验弱阳性。结论①基础血TG值正常的胰腺炎病人，每日输注占总热卡40%～50%的脂肪乳剂均能耐受；②伴高TG血症的胰腺炎病人，应根据基础血TG值增高的程度及是否存在空腹乳状血清，来判断应用、慎用或不用肪脂乳剂。【关键词】胰腺炎胃肠外营养甘油三酯脂肪乳剂ClinicalstudyonthetoleranceoflipidemulsioninfusioninpatientswithseverepancreatitisZHOUYakui,SHIHaian,HEYaoming,etal.SecondAffiliatedHospitalofHubeiMedicalUniversity,Wuhan,430071【Abstract】ObjectiveTostudythetoleranceoflipidemulsioninfusioninpatientswithseverepancrea-titis.Method33patientswithseverepancreatitiswereprospectivelystudied.Amongthem,27caseswithnormalbasalserumtriglyceride(TG)levelswererandomlydividedintoA、BandCgroups,theother6caseswithhypertriglyceridemiawereallottedtogroupD.IngroupA,eachwassupplied800～1000kcal/dbyglucoseassolefuelsource,bothgroupBandCreceivedglucoseandlipidemulsionasdualcaloriessubstrates(thefatcaloriesaccountfor40percentoftotalcaloriesingroupBand50percentingroupC,respectively).TheconstitutionofcaloricsubstratesingroupDdependedonthelevelsofserumTGandglucose.Thetolerantabilityoflipidemulsioninfusionwasinvestigatedbythefatclearancetest.ResultsThetolerantabilitiesweregoodingroupBandCundertheconditionof65.0～80.0g/dfatinfusion.IngroupD,thefatclearancetestswerepositiveinfivecaseswithserumTG>4.06mmol/Landfastingserumlactescent,anothercasewasweaklypositivewithserumTGbeing3.14mmol/Landclearfastingserum.Conclusion①ForseverepancreatitispatientswithnormalserumTGlevels,infusionoffat65.0～80.0g/distolerable.②Forthosewithhypertriglyceridemia,whethertouse,ornottouselipidemulsiondependsontheabnormalofbasalserumTGlevelandwhetherfastinglactescentserumispresent.【Keywords】PancreatitisParenteralnutritionHypertriglyceridemiaFatemulsionTriglycerids肠外营养(PN)是重症胰腺炎外科治疗的重要