外科と代謝・栄養_51巻2号.indb
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- さみら めいこ
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1 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 oil OO fish oil FO 4 MCT IVFEs n 6 polyunsaturated fatty acid PUFA n 6 PUFA 1990 IVFEs Ⅲ 第 1 世代 IVFEs 誕生の歴史考証 1679 Curten IVFEs Wretlind SO IVFEs Intralipid 50 3 Wretlind IVFEs parenteral nutrition PN lipid carbohydrate system 4 PN 1920 IVFEs Yanol Fatgen Fatgen D IVFEs 25 ml 4 Fatgen D
2 56 図 1 IVFEs 7 Fatgen D IVFEs SO Intralipid 7 2 Intrafat Intralipos IVFEs Ⅳ IVFEs 世代進化の原動力となった諸問題 IVFEs PN lipid carbohydrate system 4 PN IVFEs IVFEs IVFEs 1 IVFEs SO 100 n 6 PUFA n 3 PUFA eicosapentaenoic acid EPA docosahexaenoic acid DHA IVFEs 2 PN SO IVFEs essential fatty acid deficiency EFAD SO IVFEs 3 PN associated liver disease PNALD PNALD PN IVFEs PN 2
3 表 1IVFEs FA n 6 n 3 kcal/l Intralipid Nutrilipid Lipofundin Lipovenoes Structolipid ClinOleic Clinolipid Lipidem Lipoplus SMOFlipid Omegaven SO 100 SO 100 SO MCT SO MCT SO MCT OO SO OO SO MCT SO FO MCT SO FO SO MCT OO FO FO FA SO MCT OO FO PN PNALD 2 PNALD IVFEs phytosterol long chain triglyceride LCT 10 SO SO IVFEs IVFEs MCT LCT structured triglyceride STG 3 2 STG SO LCT MCT MCT LCT 2 MCT 2 IVFEs 11 STG IVFEs LCT/MCT IVFEs 2 Pharmaconutrient Pharmaconutrient IVFEs FO DHA EPA pharmaconutrient 12 FO 4 IVFEs Ⅴ 世界で供給されている IVFEs の現況 表 IVFEs 2 STG IVFEs Structolipid 3 IVFEs OO SO 8 2 OO n 9 65
4 58 4 IVFEs Omegaven FO IVFEs 10 PN FO 13 PNALD 14 clinicaltrials.gov NCT NCT SMOFlipid 4 SO MCT OO FO 1 IVFEs IVFEs 1 PN lipid carbohydrate system Glucose system IVFEs IVFEs 2013 Food and Drug Administration FDA 3 Clinolipid 1000 ml 2 4 Omegaven FDA FDA Ⅵ 臨床効果の検証 IVFEs IVFEs 1 IVFEs 1/2 4 IVFEs 2 3/4 IVFEs Edmuds International Nutrition Survey INS 12, PN 5 IVFEs PN 70 SO/ MCT/OO/FO PN OO FO PN SO PN ICU FO PN 19 Manzanares randomized controlled trial RCT 6 PN LCT MCT FO IVFEs vs. LCT MCT IVFEs 1 LCT LCT/MCT FO IVFEs vs. LCT LCT MCT IVFEs 3 enteral nutrition EN EN FO IVFEs vs. EN EN FO IVFEs vs. EN
5 FO IVFEs ICU RCT PN 6 LCT MCT FO IVFEs vs. LCT MCT IVFEs 3 LCT FO IVFEs vs. LCT IVFEs 2 OO FO IVFEs vs. OO IVFEs 1 EN 4 EN FO IVFEs vs. EN 1 EN FO IVFEs vs. EN 1 EN PN FO IVFEs vs. EN/PN/ 1 EN PN FO IVFEs vs. EN/PN FO IVFEs EN RCT 5 RCT FO IVFEs 0.64 p IVFEs 2 ASPEN SO IVFEs PN g 18 2 Omegaven EFAD Omegaven 19 T PN 17 2 PN EFAD Omegaven FDA Omegaven 0.2 g/kg/day 0.67 g/kg/day 17 Triene Tetraene EN 46 Omegaven PN Omegaven EFAD 3 PNALD 4 IVFEs 2015 PNALD 4 IVFEs Omegaven SMOFlipid Lipidem ,012 4 IVFEs parenteral nutrition associated cholestasis PNAC 2 2 mg/dl
6 60 PNAC PNALD PNALD Omegaven 1.0 g/ kg/day compassionate use PNALD Omegaven 1.0 g/kg/ day mg/ dl PN Pediatric End Stage Liver Disease PELD scores 4 IVFEs PNALD 4 STG IVFEs IVFEs STG PN STG IVFEs Structolipid LCT/MCT IVFEs Lipofudin Lipovenoes STG IVFEs ALT AST GGT PubMed Ⅶ 今後の展望 4 IVFEs personal communication IVFEs 表 1 2 IVFEs IVFEs 4 IVFEs SMOFlipid SMOFlipid PNALD Omegaven IVFEs 4 IVFEs 1
7 SMOFlipid Intralipos IVFEs Intralipos 1981 SMOFlipid SMOFlipid EN PN EN PN , /65 4,900 1, Omegaven Omegaven Omegaven 1 1 IVFEs Ⅷ おわりに 1 IVFEs IVFEs 文献 1 Vanek VW, Seidner DL, Allen P et al. ASPEN position paper clinical role for alternative intravenous fat emulsions. Nutr Clin Pract , Biesboer AN, Stoehr NA A Product Review of Alternative Oil Based Intravenous Fat Emulsions. Nutr Clin
8 62 Pract , , Wretlind A Parenteral nutrition. Surg Clin North Am , , Fatgen , Intralipos TM Arc Jap Cir , Accessed Jan. 10, info/kobetu/kenkou/ryumachi/dl/jouhou01 08.pdf Accessed Jan. 10, Kumpf VJ Parenteral nutrition associated liver disease in adults and pediatric patients. Nutr Clin Pract , Wu GH, Zaniolo O, Schuster H et al. Structured triglycerides versus physical mixtures of medium and long chain triglycerides for parenteral nutrition in surgical or critically ill adult patients systematic review and meta analysis. Clin Nutr Jan 21. Epub ahead of print 12 Pharmaconutrition Pharmaconutrient INTENSIVIST , De Meijer VE, Le HD, Meisel JA et al. Parenteral fish oil as monotherapy prevents essential fatty acid deficiency in parenteral nutrition dependent patients. J Pediatr Gastroenterol Nutr , Le HD, de Meijer VE, Robinson EM et al. Parenteral fish oil based lipid emulsion improves fatty acid profiles and lipids in parenteral nutrition dependent children. Am J Clin Nutr , Edmunds CE, Brody RA, Parrott JS et al. The effects of different IV fat emulsions on clinical outcomes in critically ill patients. Crit Care Med , Manzanares W, Dhaliwal R, Jurewitsch B et al. Parenteral fish oil lipid emulsions in the critically ill a systematic review and meta analysis. JPEN J Parenter Enteral Nutr 38 28, Manzanares W, Langlois PL, Dhaliwal R et al. Intravenous fish oil lipid emulsions in critically ill patients an updated systematic review and meta analysis. Crit Care , Taylor BE, McClave SA, Martindale RG et al. 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 , Gura KM, Parsons SK, Bechard LJ et al. Use of a fish oil based lipid emulsion to treat essential fatty acid deficiency in a soy allergic patient receiving parenteral nutrition. Clin Nutr , 2005 Park HW, Lee NM, Kim JH et al. Parenteral fish oil containing lipid emulsions may reverse parenteral nutrition associated cholestasis in neonates a systemic review and meta analysis. J Nutr , Premkumar MH, Carter BA, Hawthorne KM et al. Fish oil based lipid emulsions in the treatment of parenteral nutrition associated liver disease an ongoing positive experience. Adv Nutr , Nandivada P, Chang MI, Potemkin AK et al. The natural history of cirrhosis form parenteral nutrition associated liver disease after resolution of cholestasis with parenteral fish oil therapy. Ann Surg , , toukei/list/dl/seikatsu_chousa_c_h23.pdf Accessed Jan. 10, A mhlw grants.niph.go.jp/niph/search/download. do?nendo 2011&jigyoId &bunkenNo A&pdf A0003.pdf Accessed Jan. 10, 2017
外科と代謝51巻6号.indb
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