比較短期使用間歇式與連續式全靜脈營養法對代謝影響

間歇式全靜脈營養治療方式被認為可預防因使用全靜脈營養而引發的肝功能異常。本實驗擬探討間歇式與連續式全靜脈營養治療對住院患者代謝的影響。36位接受全靜脈營養治療的病患，隨機給予間歇式全靜脈營養治療 ( N=17 )，或連續性全靜脈營養治療 ( N=19 )。並在治療前、治療一週後、治療二週後、治療三週後及治療四週後檢測患者的血液肝功能指數，加以比較。治療前，二組患者的年齡、性別、血清白蛋白值、GPT值、膽紅素值及鹼性磷酸酶值無明顯差異，不過間歇式全靜脈營養治療組的血清GOT值較連續性全靜脈營養治療組為低(39.18±6.22 VS. 23.79±2.90 IU/L,P=0.027)；治療四週後，二組患者彼此間的各種肝功能指數並無明顯差異。但在使用過全靜脈營養治療兩週後，連續式全靜脈營養治療組鹼性磷酸酶比治療前有增高之情形且持續至第四週(592.67±95.13 VS. 264.21±34.07 IU/L, P=0.003），而間歇式全靜脈營養治療組在治療第三週也有類似現象 ( 429.13±43.98 VS.251.47±26.81 IU/L, P=0.002 )。本研究結果顯示投予間歇式或連續式全靜脈營養方式，對短期住院患者的肝功能影響並無顯著差異，但兩者並不能減輕鹼性磷酸酶升高的現象。

It has been suggested that cyclic infusion of total parenteral nutrition (TPN) solution can avoid the hepatobiliary complication induced by continuous infusion. This study further compares the impacts of cyclic and continuous TPN on inpatients’ metabolism 36 patients who needed TPN were randomly assigned to either cyclic (N=17) or continuous TPN (N=19) therapies. Liver biochemistry was examined before treatment and respectively at the end of the first, second, third and fourth week. The two groups have no significant differences in age, sex and serum levels of albumin, glutamate-pyruvate transferase, alkaline phosphatase and bilirubin. Nonetheless, serum levels of glutamate-oxaloacetate transferase in the group taking cyclic TPN were lower than those in the group taking continuous TPN (39.18±6.22VS 23.79±2.90 IU/L, P=0.027). The cyclic group and continuous TPN group had no significant differences in each parameter of liver biochemistries at the end of the fourth week. However, serum levels of alkaline phosphatase at the end of the second week were considerably higher than those examined during enrollment in both continuous group(592.67±95.13 VS. 264.21±34.07 IU/L, P=0.003)and cyclic group (429.13±43.98 VS.251.47±26.81 IU/L, P=0.002). We therefore concluded that cyclic TPN, compared with continuous TPN, cannot effect inpatients’ liver function or prevent the increase of serum alkaline phosphatase in short-term.