外科と代謝51巻6号.indb

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1 特集 1 2 脂質, 静脈脂肪製剤, 侵襲, 周術期管理 Ⅰ はじめに RCT 1 α- 1 1g 9 kcal SO MCT OO FO 4 1 表 1 SO SO MCT OO FO SMOF ESPEN recommendation 2

2 332 表 1 n n α- n EPA n DHA n n MCT SFAs Phytosterol concentration mg/100 mg oil α Tocopherol concentration mg/100 mg oil g/kg/day Review g/kg/day maximum 2.0 g/kg/day SO current clinical practice guidelines 7 10 SO based 4 European guideline 2 3 RCT SO SO ω6 SO 2 ω6 SO MCT OO FO FO Mix 5 7 Pubmed 2010 表 2 FO 図 1 5 ω6 ω3 FO FO vs MCT 5 RCT 2 Lipopulas 3 Omegaven 4 RCT FO Han 10 Grau Carmona vs FO SO 3 RCT IL6,TNFα FO 2 CD4/8 1 FO SIRS Mortality FO 3 FO OO 16 5 sepsis 2 5 Clinoleic Baxter Omegaven OO

3 表 2 1 FO vs MCT Barbosa Patient with SIRS or sepsis Lipopulas vs MCTs/LCTs IL6,TNF Lipopulas ICU Mortality Sungurtekin sepsis group IL6 IL Lipofundin Patient with SIRS or sepsis Omegaven vs MCTs/LCTs Han Patient in surgical ICU after major surgery de Miranda Torrinhas Grau Carmona Patient who have undergone elective surgery for the resection of gastric or colon cancer Omegaven vs MCTs/LCTs Lipofundin Omegaven vs MCTs/LCTs Lipovenoes Lipofundin Patient in ICU Lipopulas vs MCTs/LCTs 2 FO vs SO Jiang Patient who have undergone GI cancer surgery Zhu Patient who have undergone major abdominal surgery Wei Patients who have undergone gastric surgery Omegaven vs SO TNF Omegaven IL10 IL 1, IL 8, IFN γ IL 6, and TNF Omegaven MCT/LCTs IL6 FO IL10 FO postoperative liver dysfunction 50 vs 33.3 and infection rate 41.7 vs vs 37.2 ICU 1 8 CD4/CD8 ratio 4 vs 12 SIRS 4vs 13 4 vs 12 Omegaven SO vs SO IL6,TNF CD4/CD8 Omegaven Omegaven SO vs SO 3 FO vs OO Gultekin Patients with sepsis Omegaven SO/OO FO SMOF vs MCT 5 FO SMOF vs SO Ma Patients who have undergone elective GI surgery Wu Patients who have undergone GI surgery Klek Patients unable to sustain oral/enteral food intake for at least 4 wk Metry Patients in ICU after major abdominal surgery 6 OO vs SO Mateu-de Antonio Criticallyill mainly post surgery ICU Clinoleic vs OO FO SMOFLipid vs MCT Lipovenoes FO SMOFLipid vs MCT Lipovenoes SMOFLipid vs SO SMOFLipid vs SO ClinOleic vs SO Umpierrez et al. Adult medical surgical ICU patients ClinOleic vs SO OO vs MCT Garcia-de-Lorenzo severely burned patients ClinOleic vs MCT et al Lipofundin SO IL6,TNF Omegaven IL6,TNF.CRP LTB4 Omegaven IL1,IL6,TNF 2 IL10,IL6,TNF 2 SIRS FO FO Mortality 2 2 IL vs 17.9 SO 4 7 IL6 SMOF CRP CRP TNF liver function tests MCT OO ICU

4 334 ω 6:ω 3 Ratio 1:8 100% FO Omegaven 2.5:1 30% SO,30% MCT 25% OO, 15% FO SMOF lipid 2.7:1 40% SO,50% MCT 10% FO Lipoplas 7:1 100% SO Intralipid 9:1 20% SO,80% OO ClinOleic 図 1 5 ω3 ω6 50% SO,50% MCT Lipofundin MCT/LCT Lipovenoes MCT CRP LTB4 IL6 TNF α 4 SMOF MCT SMOF lipid SMOF SO30 MCT30 OO25 FO15 Fresenius Kabi 19 SMOF MCT RCT 2 Omegaven ICU 2 SMOF MCT 5 SMOF SO SMOF SO RCT 2 SMOF 4 7 IL6 6 OO SO OO OO 24 OO 2 1 ClinOleic Baxter Healthcare 1 SMOF Lipid Fresenius Kabi ClinOleic OO SO OO ClinOleic SO RCT 2 ClinOleic SO SO MCT 7 OO MCT 25 OO ClinOleic MCT Lipofundina CRP AST ALT ALP γ GTP OO FO RCT FO SMOFlipid Omegaven

5 FO ω 6 ω 3 4 Meisel Intralipid Baxter/Fresenius Kabi Liposyn II Hospira Inc ClinOleic Baxter/Clinte SMOFlipid Fresenius Kabi Omegaven Fresenius Kabi 2.4 g/kg H&E Oil Red O MR spectroscopy Serum ALT Omegaven TPN 20 FO AST ALT 27 SO FO FO 100 SO 8 33 FO 28 TPN FO ARDS FO Hecker 29 ARDS SO based oil FO based oil Volunteer Volunteer Omegaven FO Lipoven SO 48 LPS 8 24 BALF 24 BALF FO TNF α 8 SO FO IL8 24 FO SO Monocyte PMN LPS SO PMN IL8 FO Monocyte TNF α IL1β Monocyte SO FO ω3 resolvin E1 ChemR23 Volunteer FO FO ChemR23 signaling FO FO Omegaven 19 Omegaven SO Omegaven 27 TPN 100 FO SO FO

6 FO SO FO 67 SO 33 FO 33 FO 0 FO 8 FO TNF α IL FO SO 1 SO SO ω6 SO SO Furukawa 30 A B 7 14 Intralipid 1 2 IL6 CRP ConA PHA IL6 B A 2 1 B2 B1 CRP B B2 B1 Con A PHA 7 A B B2 A2 A1 SO IL6 T 1 SO IL6 CRP 文献 1 Fell GL, Nandivada P, Gura KM et al. Intravenous Lipid Emulsions in Parenteral Nutrition. Adv Nutr Sep , Singer P, Berger MM, Van den Berghe G et al. ES- PEN guidelines on parenteral nutrition Intensive care. Clin Nutr , Patkova A, Joskova V, Havel E et al. A Systematic Review. Adv Nutr , Taylor BE, McClave SA, Martindale RG Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine SCCM and American Society for Parenteral and Enteral Nutrition A.S.P.E.N. Crit Care Med , Abbasoglu O, Hardy G, Manzanares W et al. Fish Oil Containing Lipid Emulsions in Adult Parenteral Nutrition A Review of the Evidence. JPEN J Parenter Enteral Nutr, 2017 Epub ahead of print 6 Tian H, Yao X, Zeng R Safety and efficacy of a new parenteral lipid emulsion SMOF for surgical patients asystematic review and meta analysis of randomized controlled trials Nutr Rev , Calder PC Lipids for intravenous nutrition in hospital-

7 ised adult patients a multiple choice of options Proc Nutr Soc , Barbosa VM, Miles EA, Calhau C et al. Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients a randomized, controlled clinical trial. Crit Care 14 1 R5, Sungurtekin H, Degirmenci S, Sungurtekin U et al. Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis. Nutr Clin Pract , Han YY, Lai SL, Ko WJ et al. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract , de Miranda Torrinhas RS, Santana R, Garcia T et al. Parenteral fish oil as a pharmacological agent to modulate post operative immune response a randomized, double blind, and controlled clinical trial in patients with gastrointestinal cancer. Clin Nutr , Grau Carmona T, Bonet Saris A, Garcia de Lorenzo A et al. Influence of n 3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients ICU lipids study. Crit Care Med , Jiang ZM, Wilmore DW, Wang XR et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg , Zhu MW, Tang DN, Hou J et al. Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery. Chin Med J Engl , Wei Z, Wang W, Chen J et al. A prospective, randomized, controlled study of omega 3 fish oil fat emulsion based parenteral nutrition for patients following surgical resection of gastric tumors. Nutr J 13 25, Gultekin G, Sahin H, Inanc N et al. Impact of omega 3 and omega 9 fatty acids enriched total parenteral nutrition on blood chemistry and inflammatory markers in septic patients. Pak J Med Sci , Ma CJ, Sun LC, Chen FM et al. A double blind randomized study comparing the efficacy and safety of a composite vs a conventional intravenous fat emulsion in postsurgical gastrointestinal tumor patients. Nutr Clin Pract , Wu MH, Wang MY, Yang CY et al. Randomized clinical trial of new intravenous lipid SMOFlipid 20 versus medium chain triglycerides/long chain triglycerides in adult patients undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr , Klek S, Chambrier C, Singer P et al. Four week parenteral nutrition using a third generation lipid emulsion SMOFlipid a double blind, randomized, multicentre study in adults. Clin Nutr , Metry AA, Abdelaal W, Ragaei M et al. SMOF lipid versus intralipid in postoperative ISU patients. J Anesth Crit Care Med , Mateu de Antonio J, Grau S, Luque S et al. Comparative effects of olive oil based and soyabean oil based emulsions on infection rate and leucocyte count in critically ill patients receiving parenteral nutrition. Br J Nutr , Umpierrez GE, Spiegelman R, Zhao V et al A double blind, randomized clinical trial comparing soybean oil based versus olive oil based lipid emulsions in adult medical surgical intensive care unit patients requiring parenteral nutrition. Crit Care Med , Yaqoob P Monounsaturated fatty acids and immune function. Eur J Clin Nutr 56, Suppl 3, S9 S13, Garcıa de Lorenzo A, Denia R, Atlan P et al. Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients a randomised double blind study of an olive oil based lipid emulsion v. medium/long chain triacylglycerols. Br J Nutr 94, , Meisel JA, LeHD, de Meijer VE et al. Comparison of 5 intravenous lipid emulsions and their effects on hepatic steatosis in a murine model. J Pediatr Surg , Moriya T, Fukatsu K, Maeshima Y et al. The effect of adding fish oil to parenteral nutrition on hepatic mononuclear cell function and survival after intraportal bacterial challenge in mice. Surgery , Moriya T, Fukatsu K, Iwaya K et al. Influence of fish to soybean oil ratio on hepatic mononuclear cell function and survival after intraportal bacterial challenge in

8 338 parenterally fed mice. Surgery , Hecker M, Linder T, Ott J et al. Immunomodulation by lipid emulsions in pulmonary inflammation a randomized controlled trial. Crit Care , Furukawa K, Yamamori H, Takagi K et al. Influences of Soybean Oil Emulsion on Stress Response and Cell Mediated Immune Function in Moderately or Severely Stressed Patients. Nutrition , 2002

外科と代謝・栄養_51巻2号.indb

外科と代謝・栄養_51巻2号.indb 51 2 2017 4 55 特集 Ⅰ はじめに intravenous fat emulsions IVFEs Ⅱ IVFEs の世代分類図 1 American Society for Parenteral and Enteral Nutrition AS- PEN 1 IVFEs 2 IVFEs soybean oil SO medium chain triglyceride MCT olive