臺灣博碩士論文加值系統

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.

目次.........................................................................................................................Ⅰ
中文摘要..................................................................................................................V
Abstract ...................................................................................................VI
第一章 前言..........................................................................................1
第二章 文獻探討..................................................................................2
一 、全靜脈營養................................................................................................... 2
二 、全靜脈營養引起肝臟病變之病態生理 ......................................................3
三 、靜脈營養法引起肝膽併發症之營養處.......................................................8
四 、間歇式靜脈營養 ......................................................................................10
第三章 研究目的..................................................................................14
第四章 研究方法.......................................................................15
一 、研究設計......................................................................................................15
二 、研究流程......................................................................................................15
三 、統計方法......................................................................................................17
第五章 實驗結果....................................................................................19
第六章 討論............................................................................................25
第七章 結論............................................................................................39
第八章 參考文獻....................................................................................73

表 目 次
表 1. 台南市立醫院全靜脈營養配方..............................................................41
表 2. 二組患者基本資料之比較......................................................................42
表 3. 兩組患者之全靜脈營養適應症..............................................................43
表 4. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組患者全靜脈營
養停用原因..............................................................................................43
表5-1 間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案血糖的變
化..............................................................................................................44
表5-2. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組血糖的變化47
表6-1. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案熱量的變
化..............................................................................................................48
表6-2. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組熱量的變化49
表7-1. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案體重的變
化..............................................................................................................50
表7-2. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組體重的變化51
表8-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案白蛋白的
變化..........................................................................................................52
表8-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組血清白蛋白的
變化.. ...................................................................................................... 55
表9. albumin值與BIL的皮爾森積差(r)相關矩陣....................................56
表10-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案TG的變
化..............................................................................................................57
表10-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組血清TG的變
化............................................................................................................58
表11-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組GOT值個案的
變化........................................................................................................61
表11-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組GOT值的變
化..............................................................................................................62
表12-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案GPT的變
化..............................................................................................................63
表12-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組血清GPT的變
化........................................................................................................... ..64
表13-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組T.BIL個案的
變化........................................................................................................ .65
表13-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組T-BIL的變
化.............................................................................................................66
表14-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案D.BIL的
變化..........................................................................................................67
表14-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組D.BIL的變
化………................................................................................................68
表15-1.間歇式全靜脈營養治療組與連續式全靜脈營養治療組個案
ALK-P值的變化.....................................................................................69
表15-2.間歇式全靜脈營養治療組與連續式全靜脈營養治療組ALK-P值的變
化..............................................................................................................70
表16. 間歇式全靜脈營養治療組與連續式全靜脈營養治療組肝功能指數的變
化..............................................................................................................71

圖目次

圖1. 使用TPN病患肝功能異常時的建議處理步驟流程.................................8
圖2. 研究步驟流程圖 .....................................................................................18
圖3-1. 間歇治療組與連續治療組血糖常態分佈圖...........................................45
圖3-2. 間歇治療組與連續治療組血糖之變化...................................................47
圖4. 間歇治療組與連續治療組熱量之變化………………...........................49
圖5. 間歇治療組與連續治療組體重之變化...................................................51
圖6-1. 間歇式治療組與連續式治療組血清白蛋白常態分佈圖.......................53
圖6-2. 間歇式治療組與連續式治療組血清白蛋白之變化...............................55
圖7. albumin值與BIL的皮爾森積差相關bar形圖.....................................56
圖8-1. 間歇式治療組與連續式治療組血清三酸甘油脂常態分佈圖.............. 57
圖8-2. 間歇式與連續式全靜脈營養治療血清三酸甘油脂值的變化...............60
圖 9. 間歇式與連續式全靜脈營養治療GOT的變化........................................62
圖10. 間歇式與連續式全靜脈營養治療GPT的變化.........................................64
圖11. 間歇式與連續式全靜脈營養治療T.BIL的變化.....................................66
圖12. 間歇式與連續式全靜脈營養治療D.BIL的變化.....................................68
圖13. 間歇式與連續式全靜脈營養治療ALK-P的變化.....................................70
圖14. 兩組肝功能指數的變化...........................................................................72

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