Nutritional Support After Resection of the Cirrhotic Liver - Utilization of Fat Emulsion

认为肝硬变患者营养不良可能是肝切除术后发生肝功能衰竭的原因之一。一般来说，在肝硬变切除后不久给予脂肪乳剂一直被认为是避免的。我们试图从实验上阐明肝硬变切除后给予外源性脂肪的利用及其对网状内皮功能的影响。大鼠肝硬变切除后，分别给予5%葡萄糖30卡/公斤/天(I组)、5%葡萄糖+20%脂肪乳剂200卡/公斤/天(II组)、5%葡萄糖+20%脂肪乳剂200卡/公斤/天+肉碱250 mg/kg(III组)。肝切除12小时后，给予14&gt；C标记脂肪乳剂，测定5小时累积二氧化碳回收率。虽然I组的CO_2恢复率为22%，但与对照组相比显著下降(肝切除未进行…肝脏ATP含量和血β-羟丁酸浓度也显著高于I组和II组。为了阐明脂肪乳剂的适宜配比，以脂肪含量为20%、30%和40%的脂肪含量为指标，进行了CO_2回收率的测定。其中，30%的脂肪含量回收率最高。网状内皮吞噬指数：Ⅲ组和Ⅰ组显著高于Ⅱ组，说明肉碱对外源脂肪的利用起着重要作用，应适当补充脂肪组合。脂肪乳剂的充分利用逆转了网状内皮细胞吞噬功能的恶化，脂肪利用的临床研究主要采用间接量热法。术前脂肪耐量试验证实脂肪利用率越高，肝功能损害越严重。术后应用脂肪乳剂，充分利用了术后疗程。为使术后营养不良早日恢复，建议积极应用脂肪乳剂。较少

It is considered that poor nutritious condition associated with liver cirrhosis may contribute to induce liver failure after hepatic resection. In general, administration of lipid emulsion shortly after resection of the cirrhotic liver has been thought to be avoided. We have attempted to clarify theutilization of exogenous fat given after resection of the cirrhotic liver and its influence on the reticuloendothelial function experimentally. After resection of the cirrhotic liver in rats, 30 cal/kg/day of 5% glucose (Group I), 200Cal/kg/day of 5% glucose with 20% fat emulsion (Group II), and 200 Ca1/Kg/day of 5% glucose and 20% fat emulsion with 250 mg/kg of carnitine (Group III) were administered, respectively. Twelve hours after hepatic resection, ^<14>C labeled fat emulsion was administered and cumulative ^<14>CO_2 recovery for 5 hours was measured. Although ^<14>CO_2 recovery was 22% in Group I which was significantly decreased as compared to controls (hepatic resection was not perfo … More rmed), that was 28% in Group II and 37% in Group III. Hepatic ATP content and blood bata-hydroxybutyric acid concentration were also significantly higher in Group III than in Group I and Group II. In order to elucidate the proper combiation of fat emulsion, ^<14>CO_2 recovery was examined using fat contents of 20, 30 and 40%. 30% of fat content showed the highest recovery among those. Reticuloendothelial phagocytic index was significantly higher in Grup III and Group I than in Group II. In conclusion carnitine played important rolefor the utilization of exogenous fat, and appropriate combination of fat must be adiministered. Deterioration of reticuloendothelial phagocytic function was reversed in accordance with the sufficient utilization of fat emulsion.Clinical studies for the utilization of fat fave been mainly conducted using indirect calorimetry. Preoperative fat tolerance test clarified that the greater fat utilization deteriorated, the severer hepatic dysfunction existed. In postoperative periods, administered fat emulsion was well utilized postoperative course. In order to obtain early recovery from malnutrition after operative interventions, aggressive administration of fat emulsion can be recommended in those patients. Less