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10 1Vol.10 No.1 20031Parenteral&EnteralNutritionJan.2003· ·吴 国 豪(,200032): ; : R459.3 : C : 1007-810X(2003)01-0060-040 、。,,,,,。,,,。[1,2],,、。,,。、。1 ,(ployunsaturatedfattyacid,PUFA),,(lipidperoxidation)。、。,,O2(ROO-),,。。,。,,,。,。,。PUFA,、,(Malonaldehyde)4-hydroxyalkenal,。、PU-FA,“”。、,。,,,Ca2+。Na+-K+-ATP,Na+,Na+-Ca2+-ATP,。,,·60·: 2002-02-20: (1964-),,,,,。DOI:10.16151/j.1007-810x.2003.01.023Ca2+,Ca2+,Ca2+,Ca2+,。,、、。:①;②。③。,,。,,。,,,、。,γ-E,α-E(α-toco-pherol),α-EE,,,。,,。。,,[3]。,,,[4]。2 ,、、(ARDS)、-,,,,。、、,。,。,,,[5,6]。[7]。ARDS,,,,[8]。,,。,。,,,,。,[9,10〗。Pitka-nen[11],,。,,,10[12]。Lemoyne[4],,,。,α-E,E,。,(/,,),,,,。,。,、、、。Lnder[13],。,PUFA,,。3 ,、、、。α-E、·61· 1 、,。,,,。,。Eα-,β-,δ-,γ-tocopherolα-,β-,δ-,γ-tocotrienols。α-E。E,。,[14,15]。,,。,E,。E,E。[4,16],,α-E,α-E,α-E。VanGossum[17],E。,,E。[3],,E,E。,α-E,20mg/d200mg/d。E。E0.7～1.6mg/100ml,0.4mg/100mlE。,α-EE,0.8mg/g,E。E,,25%E。,E,、,。,。,E,。,,E,。WispeE。Schmitzα-E1.5mg,。,,α-E25～50mg。[18],E,10mgα-EE。Vandewoude[19],E,2,17Uα-E,E。2,31%E。,,α-E。Siderova[20]200mgα-E,α-E,LDL,。[21],。,α-E(Lipofundin★RMCT/LCT,B.BRAUN)。Linseisen[22],α-E,E,。:[1] RosenGM,PouS,RamosCL,etal.Freeradicalsandphagocyticcells[J].FASEBJ,1995,9:200.[2] MoslenMT.Reactiveoxygenspeciesinnormalphysiology,cellinjuryandphagocytosis.Freeradicalsindignosticmedicine[M].NewYork:ArmstrongDPlenumPress,1994.[3] GuohaoWu,JarstromC,NordenstromJ.Phagocyteinducedlipidperoxidationofdifferentintravenousfatemulsionsandcounterac-tiveeffectofvitaminE[J].Nutriiton,1999,15(5):359-364.[4] LemoyneM,VanGossumA,KurianR,etal.PlasmavitaminEandseleniumandbreathpentaneinhomeparenteralnutritionpa-tients[J].AmJClinNutr,1988,48:1310-1315.[5] FriedlHP,SmithDJ,TillGO,etal.Ischemia-reperfusioninhu-mans.Appearanceofxanthineoxidaseactivity[J].AmJPathol,1990,136:491-495.[6] SussmanMS,BulfleyGB:Oxygen-derivedfreeradicalsinreper-fusioninjury[J].MethEnzymol,1990,186:711-723.[7] GalleyHF,RichardsonN,HowdlePD,etal.Totalantioxidantcapacityandlipidperoxidationduringlivertransplantationv[J].·62· 20031 10 ClinicalScience,1995,89:329-332.[8] SznajderJI,FraimanA,HallJB,etal.Increasedhydrogenperox-ideintheexpiredbreathofpatientswithacutehypoxemicrespi-ratoryfailure[J].Chest,1989,96:606-612.[9] StegerPJK,MuhlebachSF.InvitrooxidationofⅣlipidemul-sionsindifferentall-in-oneadmixturebagsassessedbyaniodo-metricassayandgas-liquidchromatography[J].Nutrition,1997,13:133-140.[10] StegerPJK,MuhlebachSF.LipidperoxidationofⅣlipidemul-sionsinTPNbags:Theinfluenceoftocopherols[J].Nutrition,1998,14:179-185.[11] PitkanenOM.Peroxidationoflipidemulsions:ahazardfortheprematureinfantreceivingparenteralnutrition?[J]FreeRadicalBiology,1992,13:239-245.[12] PitkanenO,HallmanM,AnderssonS.Generationoffreeradicalsinlipidemulsionusedinparenteralnutrition[J].PediatrRes,1991,29:56-59.[13] InderTE,DarlowBA,SluisKB,etal.Thecorrelationofelevat-edlevelsofanindexoflipidperoxidationwithadverseoutcomeintheverylowbirthweightinfant[J].ActaPaediatr,1996,85(9):1116-1122.[14] MoslenMT.Reactiveoxygenspeciesinnormalphysiology,cellinjuryandphagocytosis.Freeradicalsindignosticmedicine[M].NewYork:ArmstrongDPlenumPress,1994.[15] FridovichI.Superoxidedismutase:Anadaptationtoaparamag-neticgas[J].JBiolChem,1989,264:7761-7764.[16] PironiL,RuggeriE,ZolezziC,etal.Lipidperoxidationandan-tioxidantstatusinadultsreceivinglipid-basedhomeparenteralnutrition[J].AmJClinNutr,1998,68(4):888-893.[17] VanGossumA,ShariffR,LemoyneM,etal.Increaselipidper-oxidationafterlipidinfusionasmeasuredbybreathoutput[J].AmJClinNutr,1988,48:1394-1399.[18] SteephenAC.VitaminEstatusofpatientsreceiveinglong-termparenteralnutrition:IsvitaminEsupplementaitonadequate?[J]JPEN,1991,15:647-652.[19] VandewoudeMG,VandewoudeMF,DELeeuwIH.Vitaminsta-tusinpatientsonparenteralnutritionreceivingIntralipid[J].JPEN,1986,10:303-305.[20] SiderovaVS.Intravenousα-tocopherolsupplementationinpa-tientsreceivinglong-termhomeparenteralnutrition[J].ClinNu-tr,1995,14(suppl2):47-48.[21] SilersKM,SluisKB,DarlowBA,etal.Limitinglight-inducedlipidperoxidationandvitaminlossininfantparenteralnutritionbyaddingmultivitaminpreparationstoIntralipid[J].ActaPaedi-atr,2001,90(3):242-249.[22] LiseisenJ,HoffmannJ,LienhardS,etal.AntioxidantstatusofsurgicalpatientsreceivingTPNwithanomega-3-fattyacid-con-taininglipidemulsionsupplementedwithalpha-tocopherol[J].ClinNutr,2000,19(3):177-184.( 李风华)(上接第59页)表1 营养支持效果的观察 TP(g/L)Alb(g/L)Hb(g/L)TC(mmol/L)TG(mmol/L)GPT(μmol/L)Bil(μmol/L)Urea(mmol/L)Cr(μmol/L)1999-01-11～1999-04-1168.1±3.237.5±1.8128±9.192±319.5±4.0 5.8±1.3 51.5±14 1999-04-12～1999-07-1173.4±6.539.0±4.3123.5±3.04.741.8956.5±26.213.5±8.15.1±1.159.0±16.81999-07-12～1999-10-1271.3±2.138.8±4.0126.5±5.431.5±17.57.3±0.35.3±1.158.5±5.72000-04-1268.0451223.80.99.386.62002-02-2769.54311841.67.1933 ,、,“”,。:3.1 早期合理调整配方对促进危重病人胃肠适应非常重要 ,,,,,。,“”,,、,。3.2 全面和平衡的营养素及热能供给有利于使长期经鼻饲方式肠内营养支持病人维持较好的营养状态 1245,,,。,,2.5kg,,。( 冯 萱)·63· 1