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

肝切除术后，营养不良伴肝硬化可能导致肝功能衰竭。一般认为，在肝硬化切除后不久给予脂质乳剂是可以避免的。我们试图通过实验阐明肝硬化切除后给予的外源性脂肪的利用及其对网状内皮功能的影响。切除肝硬化大鼠肝脏后，分别给予30 cal/kg/天5%葡萄糖（I组）、200 cal/kg/天5%葡萄糖加20%脂肪乳（II组）和200 Ca1/ kg/天5%葡萄糖加20%脂肪乳加250 mg/kg肉毒碱（III组）。肝切除术后12小时给予^<14>C标记脂肪乳，测定5小时累积^<14>CO_2恢复。虽然1组的CO_2恢复率为22%，明显低于对照组（未行肝切除术），但2组为28%，3组为37%。肝脏ATP含量和血羟丁酸浓度在ⅲ组显著高于ⅰ组和ⅱ组。为了阐明脂肪乳化液的合理组合，在脂肪含量为20%、30%和40%的情况下，对^<14>CO_2的回收率进行了研究。其中脂肪含量30%的回收率最高。ⅲ组和ⅰ组网状内皮细胞吞噬指数明显高于ⅱ组。综上所述，肉碱对外源脂肪的利用有重要作用，应合理搭配脂肪。随着脂肪乳的充分利用，网状内皮细胞吞噬功能的恶化得到逆转。脂肪利用的临床研究主要采用间接量热法进行。术前脂肪耐量试验表明，脂肪利用越差，肝功能越严重。术后给予脂肪乳的效果良好。为了使手术干预后营养不良的患者早日康复，可以推荐这些患者积极使用脂肪乳。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