[Applied studies of structured triglycerides for parenteral nutrition in severe hemorrhagic shock patients after resuscitation].
OBJECTIVE
To evaluate the effects of structured triglycerides in parenteral nutrition versus a physical medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) mixture on severe hemorrhagic shock patients after resuscitation.


METHODS
In a randomized trial, we studied 20 critical patients with a total blood loss of over 3000 ml perioperatively and/or intraoperatively. The use of triglycerides started from Day 3 postoperation and parenteral nutrition lasted for no less than 5 days. They were allocated to receive one of two nutrition regiments: structured triglycerides in Group A (n = 10) and MCT/LCT in Group B (n = 10). There were no significant differences of general conditions in two groups. Before the start of parenteral nutrition (d0), d1 d3 and d5 after start of infusion, the following parameters were measured: hemoglobin (Hb), platelet count (Plt), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), serum triglycerides (TG), prealbumin (PA) and transferrin (TF). And mean artery pressure (MAP), heart rate (HR) and central vein pressure (CVP) were also recorded at the same time-points. Then the post-TG changes of the above data were compared in both groups.


RESULTS
After the use of triglycerides, there were no significant differences of MAP, HR, CVP, Hb and Plt in both groups (P > 0.05). At D3 and D5, the serum levels of TG ((2.1 ± 0.4) vs (1.6 ± 0.6) mg/L, (2.3 ± 0.7) vs (1.5 ± 0.3) mg/L) and alanine aminotransferase ((133 ± 58) vs (97 ± 26) U/L; (116 ± 48) vs (77 ± 31) U/L) were significantly higher in Group B versus those receiving structured triglycerides in Group A (P < 0.05). TB ((18 ± 15) vs (18 ± 11) µmol/L) and DB ((8.9 ± 3.2) vs (8.8 ± 2.5) µmol/L) had no significant differences in two groups (P > 0.05). The serum levels of such nutrition markers as PA ((195 ± 55) vs (166 ± 55) mg/L,(245 ± 53) vs (195 ± 58) mg/L) and TF ((2.6 ± 0.5) vs (2.5 ± 0.6) g/L, (3.3 ± 0.8) vs (2.9 ± 0.6) g/L)were significantly higher in Group A than those in Group B (P < 0.05).


CONCLUSIONS
With regards to lipid metabolism, protein synthesis and hepatocyte protection, structured triglycerides in parenteral nutrition is advantageous to standard MCT/LCT emulsion in severe hemorrhagic shock patients after resuscitation.
Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China.
Mao-sheng
MS
Su
Lei
L
He
Zhi-wei
ZW
Liu
Huan-xian
HX
Ma
Qing-hua
QH
Zhao
Wen-zhi
WZ
Zhang
D000293:Adolescent; D000328:Adult; D000368:Aged; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D014280:Triglycerides / Q000627:therapeutic use*; D055815:Young Adult
D005217:Fat Emulsions, Intravenous; D014280:Triglycerides