51 6 2017 12 331 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 1 350 8550 1981 2 2 1 3 SO MCT OO FO 4 1 表 1 SO SO MCT OO FO SMOF 20 30 ESPEN recommendation 2
332 表 1 n 6 50 4 1 3 2 n 6 0 0 0 0 α- n 3 10 0 1.3 5.2 0 EPA n 3 0 0 5.4 13.9 0 DHA n 3 0 0 5.4 26.8 0 n 9 25 85 16 20 6 MCT 0 0 0 65 SFAs 15 11 10 20 27 Phytosterol concentration mg/100 mg oil 300 200 70 α Tocopherol concentration mg/100 mg oil 6.4 7.5 10 37 45 70 0.2 2 1 0.7 1.5 g/kg/day Review 3 1.0 2.0 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 8 12 1 FO vs MCT 5 RCT 2 Lipopulas 3 Omegaven 4 RCT FO Han 10 Grau Carmona 12 21 vs 37.2 2 13 15 2 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
51 6 2017 12 333 表 2 1 FO vs MCT Barbosa 2010 8 Patient with SIRS or sepsis Lipopulas vs MCTs/LCTs IL6,TNF Lipopulas ICU Mortality Sungurtekin sepsis group IL6 IL1 2011 9 Lipofundin Patient with SIRS or sepsis Omegaven vs MCTs/LCTs Han 2012 10 Patient in surgical ICU after major surgery de Miranda Torrinhas 2013 11 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 2015 12 Lipofundin Patient in ICU Lipopulas vs MCTs/LCTs 2 FO vs SO Jiang 2010 13 Patient who have undergone GI cancer surgery Zhu 2012 14 Patient who have undergone major abdominal surgery Wei 2014 15 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 27.8 21 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 2014 16 4 FO SMOF vs MCT 5 FO SMOF vs SO Ma 2012 17 Patients who have undergone elective GI surgery Wu 2014 18 Patients who have undergone GI surgery Klek 2013 20 Patients unable to sustain oral/enteral food intake for at least 4 wk Metry 2014 21 Patients in ICU after major abdominal surgery 6 OO vs SO Mateu-de Antonio Criticallyill mainly post surgery 2008 22 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 2012 23 7 OO vs MCT Garcia-de-Lorenzo severely burned patients ClinOleic vs MCT et al. 2005 25 Lipofundin SO IL6,TNF Omegaven IL6,TNF.CRP LTB4 Omegaven IL1,IL6,TNF 2 IL10,IL6,TNF 2 SIRS FO FO Mortality 2 2 IL6 2 2 17.6 vs 17.9 SO 4 7 IL6 SMOF CRP CRP TNF liver function tests MCT OO ICU
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 17 18 SMOF lipid SMOF SO30 MCT30 OO25 FO15 Fresenius Kabi 19 SMOF MCT RCT 2 Omegaven 1 17 2 ICU 2 SMOF MCT 5 SMOF SO 20 21 SMOF SO RCT 2 SMOF 4 7 IL6 6 OO SO 22 23 OO OO 24 OO 2 1 ClinOleic Baxter Healthcare 1 SMOF Lipid Fresenius Kabi ClinOleic OO SO 80 20 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
51 6 2017 12 335 FO ω 6 ω 3 4 Meisel 26 5 19 5 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
336 28 20 FO SO 1 2 33 FO 67 SO 33 FO 33 FO 0 FO 8 FO TNF α IL10 5 1 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 15 6 5 600 610, 2015 2 Singer P, Berger MM, Van den Berghe G et al. ES- PEN guidelines on parenteral nutrition Intensive care. Clin Nutr 28 387 400, 2009 3 Patkova A, Joskova V, Havel E et al. A Systematic Review. Adv Nutr 14 8 4 624 634, 2017 4 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 44 2 390 438, 2016 5 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 71 12 815 821, 2013 7 Calder PC Lipids for intravenous nutrition in hospital-
51 6 2017 12 337 ised adult patients a multiple choice of options Proc Nutr Soc 72 263 276, 2013 8 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, 2010 9 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 26 6 665 671, 2011 10 Han YY, Lai SL, Ko WJ et al. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract 27 1 91 98, 2012 11 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 32 4 503 510, 2013 12 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 43 1 31 39, 2015 13 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 97 6 804 809, 2010 14 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 125 2 178 181, 2012 15 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, 2014 16 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 30 2 299 304, 2014 17 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 27 3 410 415, 2012 18 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 38 7 800 808, 2014 19 51 55 62 2017 20 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 32 2 224 231, 2013 21 Metry AA, Abdelaal W, Ragaei M et al. SMOF lipid versus intralipid in postoperative ISU patients. J Anesth Crit Care Med 1 6 1 8, 2014 22 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 99 846 854, 2008 23 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 40 1792 1798, 2012 24 Yaqoob P Monounsaturated fatty acids and immune function. Eur J Clin Nutr 56, Suppl 3, S9 S13, 2002 25 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, 221 230, 2005 26 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 46 666 673, 2011 27 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 151 5 745 755, 2012 28 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
338 parenterally fed mice. Surgery 155 4 711 718, 2014 29 Hecker M, Linder T, Ott J et al. Immunomodulation by lipid emulsions in pulmonary inflammation a randomized controlled trial. Crit Care 19 226, 2015 30 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 18 235 240, 2002