| Objective: At present,domestic and international research metabolism and inflammatory mediators lack of change.After the adoption of researc h aimed at obtaining joint administration left carnitine nutritional support,patients with severe sepsis and systemic inflammatory response syndrome cases reduce the incidence,thereby reducing hospital costs and shorter ho spital stays.L-carnitine is an amino acid derivative,has an important role in the fatty acid(especially the long-chain fatty acid)metabolism during oxidation.Overseas studies have shown that under stress conditions,the a mount of urine loss of L-carnitine increases,lower blood levels of L-carn itine,carnitine supplementation improves nitrogen balance.Carnitine is ess ential cofactor in fatty acid metabolism,carnitine translocase it contains c arnitine acetyl transferase I,carnitine acetyl transferase II long chain fatty acids into acetyl-carnitine and its transfer necessary factor into the mitoch ondria,which generate energy ?-light substances after peroxide azole Kr ebs cycle.Fatty acid oxidation in three phases:(1)activation(intracellular fluid is completed);(2)? oxidation(completed within mitochondria);(3)t he citric acid cycle(completed within mitochondria).Fatty acids can be p art of the activation phase two high-energy phosphate bond(-p)is activat ed acyl-CoA.The fatty acyl-CoA to be transferred first enzymatic mitoch ondrial carnitine acyl before entering the citric acid cycle.The body ische mia,hypoxia,stress the long-chain acyl-CoA also accumulated in the mit ochondria,while the free carnitine due to the large consumption drasticall y reduced,further exacerbating the acyl-CoA accumulation.Ischemia,hyp oxia ATP levels drop,subcellular membranes and membrane permeability,t otal fatty acyl coenzyme A can lead to accumulation in the membrane phase disintegration,causing cell death in cell structure changes.In addition,enhanced anaerobic glycolysis under hypoxia sugars,fatty acid accumulat ion lead to acidosis,further accelerated cell death autolysis.A sufficient d ose of blood can accumulate free carnitine fatty acyl-coenzyme A into the mitochondria,reducing the adenine nucleotide translocase enzyme inhibiti on,so that the oxidative phosphorylation will be smooth,left-carnitine for the participation of fatty acid oxidation It can be supplied directly such as cardiac cells,brain cells,bone cells and other cells and tissues.Left c arnitine can increase cytochrome oxidase,NADH cytochrome C reductase activity,accelerated ATP production,participate in the detoxification of c ertain drugs.L-carnitine by energy production and improve the function of tissues and organs,reduce tissue ischemia and hypoxia.Other features of L-carnitine are: long-chain fatty acids in the secondary oxidation of t he coenzyme binding,free coenzyme composition ratio as a buffer,to ge nerate energy from amino acids(including branched-chain amino acids),a nd adjust the concentration of ammonia in the blood.Tumor after radical critically ill patients IL-1,IL-6 is the most effect ive and neutrophils major flooding agent,the latest reported in the literat ure,peak expression of IL-6 is in the peak of inflammation,in danger p atients with severe early trauma detected in serum at 3-6 times higher T NF-? IL-1 IL-6 than normal,and high levels of inflammatory mediators c an lead to or aggravate systemic inflammatory response syndrome(SIRS),left-carnitine injection is mandatory and useful supplement under sepsis patients of infectious conditions.To maintain body Neikaniting levels,red uce protein degradation,improve the level of inflammatory mediators,we use(Sunrise Pharmaceutical Co Ltd.)injection of carnitine(Carnitine)co mbined with parenteral nutrition in our hospital ICU digestive tumor rese ction patients were studied in patients with inflammatory cytokine levels after the change.At present,domestic and foreign clinical study metabolis m and inflammatory mediators lack of change.After the adoption of rese arch aimed at obtaining joint administration left carnitine nutritional support,patients with severe sepsis and systemic inflammatory response syndro me cases reduce the incidence,thereby reducing hospital costs and shorter hospital stays.Methods:1 the object of study and samplingIn the same period Baoding First Central Hospital inpatient critical c are medicine digestive system cancer patients with radical surgery and par enteral nutrition support more than seven days in patients for the study,a nd tumor surgery,gastrointestinal surgery and general surgery observationa l studies tracking.2 the methodStudy Group: Self postoperative day(POD + 1)in the nutrient soluti on according to plan: join Carnitine 40 mg / kg / day,total input 7 day s.Control group: POD + 1 nutrient solution using the same packaging placebo 40mg/kg/d.(Error is less than 5%),two of the major energy and nitrogen equivalent(calorie 30 kcal / kg / d,the nitrogen intake 1.0g / k g/d).The study group and the control group were isocaloric and nitrogen intake,nutrition doctors prescription medication daily 8:30 to go further b efore dosing dosing center nurse.Operating specifications according to nu trient solution "all in one"(AIO)arranged in the mixing chamber 1000 l aminar flow cleanness 100 clean bench.Day before 10:00 to wards.3 outcome measuresBefore treatment,the seventh day,month plasma C-reactive protein CRP,Interleukin IL-1,interleukin-6,tumor necrosis factor TNF-?,three triglyceride(TG),low density lipoprotein(LDL-C),high-density lipopro tein(HDL-C),the concentration of free carnitine(LC).4 statistical methodsUsing statistical software StatView(SAS,Institute Inc.SAS Campu s Drive,Cary,NC 27513,USA.Series no STV 04171),for data analysis.Normality of data using ANOVA analysis,non-normal data were Will coxon analysis,rate analysis by ?2 test,data were presented as mean ±standard deviation(x ± s)represented,P <0.05 was considered statistic ally significant.Results: In gastrointestinal cancer after radical resection,IL-1,IL-6,TNF-? is an important inflammatory mediator SIRS occur without trau ma and surgical stress response can cause the release of more inflamma tory mediators,thereby inhibiting gastrointestinal motility.There is no o ne drug has a clear effect on the SIRS.1 Carnitine strengthen levels of inflammatory factors decreased level(97.7%)of parenteral nutrition in the test group was significantly higher(41.6%).And,after the seventh day of serum L-1,IL-6,TNF-? expression levels of expression in the test group and the control group were41.17±10.36pg/l 69.65±13.12pg/l,31.21±9.74pg/l 56.36±6.18pg/l,19.35±8.12 pg/l 24.48±10.01 pg/l?2 TCesterol,triglycerides,high density lipoprotein(H-DLC),low-de nsity lipoprotein(L-DLC)observation showed that: two groups of patien ts were compared before and after treatment before treatment lipoprotein TG,TC,L-There was no significant difference(P> 0.05)DLC and H-DLC levels in the control group showed no significant change before t he indicators and treatment(P> 0.05);.after treatment,TG,TC,L-DLC and H-DLC before treatment and control group slightly increased,but no significant changes,the difference was not statistically significant(P>0.05),3 carnitine concentrations in blood test results show that the pre-tre atment control group and experimental comparison group no significant difference between the experimental group before and after treatment an d the concentration of total carnitine,free carnitine concentration increas ed significantly,with statistical significance(P <0.05),while the contro l group before and after treatment the concentration of total carnitine,fr ee carnitine concentrations have decreased,but not statistically significant(P> 0.05)4 Left carnitine strengthen parenteral nutrition in postoperative patie nts with gastrointestinal cancer can significantly reduce levels of inflam matory mediators in patients with P<0.05.Patient treatment study group were not damaged organ function,the control group,3 cases of abnor mal liver function(through the application of Liver drug Essentiale will polyene phosphatidylTCine injection to normal),(2cases> 60u/L P = 0.48,1cases > 80 u/L P=0.1)showed no significant difference between t he two.There was no case of severe infection complications.Left to fr ee carnitine level,whether there is a difference between infectious comp lications,length of stay and total costs two,pending the results of furth er research.Left carnitine combined with nutritional support after patients with severe sepsis and systemic inflammatory response syndrome in reducing the incidence,thereby reducing hospital costs and shorter hospital stays.Conclusion: Through comparative analysis of the experimental grou p and the control group completed the planned 60 patients with gastroin testinal cancer patients after clinical observations.We postoperative infla mmatory factors,postoperative hospital study observation date,infectionrelated complications,the cost of nutrition,nutrition indicators and the t otal cost of hospitalization cellular and humoral immunity index.The re sults show: Left carnitine strengthen parenteral nutrition in postoperative patients with gastrointestinal cancer can significantly reduce levels of i nflammatory mediators in patients with P<0.05.Treatment of patients in the experimental group were not damaged organ function,the control g roup,3 cases of abnormal liver function(through the application of Liv er drug Essentiale will polyene phosphatidylcholine injection to normal),left-carnitine enriched parenteral nutrition on liver function in patients with parenteral nutrition than simple indifference.Patients with gastrointe stinal cancer surgery can cause the body TC,FC levels drop,left carnit ine enriched parenteral nutrition is an important means of exogenous supplement,can significantly improve patients' blood TC,FC level.Short-t erm intravenous parenteral nutrition to strengthen the implementation of left-carnitine had no effect on blood lipid levels in patients.Gastrointesti nal cancer patients after carnitine-rich food intake reduction is caused b y abnormal fatty acid metabolism in patients and became one of the fac tors leading to complications of SIRS,malnutrition occurs.This may be beneficial for patients with high inhibition of the inflammatory response in gastrointestinal cancer patients... |
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