경정맥 영양요법(TPN) 시행에 따른 간기능 이상: 단기간 시행한 TPN에서 혈청 간효소의 변화
Abnormalities of Liver Function during Total Parenteral Nutrition (TPN): Alteration of Serum Liver Enzyme during Short-term TPN
김태현, 최경현, 윤기영, 서경원, 유대우, 강원근, 류동원, 이경춘, 정은애, 임선계, 김홍선, 이금숙, 김은실, 안수미,
소속 상세정보
김태현 ( Kim Tae-Hyun )
고신대학교 복음병원 외과학교실
최경현 ( Choi Kyung-Hyun )
고신대학교 복음병원 일반외과
윤기영 ( Yoon Ki-Young )
고신대학교 복음병원 외과학교실
서경원 ( Seo Kyung-Won )
고신대학교 복음병원 외과학교실
유대우 ( Yoo Dae-Woo )
고신대학교 복음병원 일반외과
강원근 ( Kang Won-Geun )
고신대학교 복음병원 외과학교실
류동원 ( Ryu Dong-Won )
고신대학교 복음병원 외과학교실
이경춘 ( Lee Kyung-Chun )
고신대학교 복음병원 외과학교실
정은애 ( Jung Eun-Ae )
고신대학교 복음병원 약재부
임선계 ( Lim Sun-Gye )
고신대학교 복음병원 약재부
김홍선 ( Kim Hong-Seon )
고신대학교 복음병원 약재부
이금숙 ( Lee Kum-Sook )
고신대학교 복음병원 간호과
김은실 ( Kim Eun-Sil )
고신대학교 복음병원 영양지원팀
안수미 ( Ahn Su-Mi )
고신대학교 복음병원 영양지원팀
KMID : 0371320020630050409
Abstract
Purpose: TPN has been widely used to treat nutritional depletion since the late 1960s. However, many metabolic complications may occur as a result of parenteral feeding. Among these, hepatic complications has received increasing attention.
A
retrospective review of liver function abnormalities in adult patients who underwent TPN was done to determine the frequency and magnitude of the abnormalities in a liver function test.
Methods: From January 2001 to Jun 2001, 160 adult patient receiving TPN were reviewed. Of these, 111 had a malignant disease and 49 had a benign disease. The duration of TPN therapy ranged from 5 days to 52 days, with a mean duration of 14
days.
Abnormalities of liver function test were defined as a value greater than the upper normal limit. Forty cases of gastric cancer were analyzed to determine the risk factors that contribute to abnormal liver function in individual patients
receiving
TPN.
Results: Abnormalities of the liver function test appeared after 6∼7 days of therapy. Increases in the ALP levels were noted in 34 out of 93 patients (37.6%), in the AST levels in 42 out of 116 patients (36.2%), in the ALT levels in 54 out
of
125 patients (43.2%), in the LDH levels in 20 out of 72 patients (27.8%), in the γ-GTP levels in 44 out of 81 patients (54.3%), and in the bilirubin levels in 30 out of 126 patients (23.8%). The serum ALP level rose to 1.6 times upper the limit
of
normal; AST, 1.7 times; ALT, 2.0 times; LDH, 1.2 times; γ-GTP, 2.4 times; bilirubin, 2.4 times. γ-GTP value was most sensitive. In 40 gastric cancers, factors as age, the amount of TPN solution, the duration of TPN, intraoperative chemotherapy,
transfusion, and postoperative infection were investigated. However, no association with TPN-associated liver function abnormalities was found.
Conclusion: The incidences of an abnormal liver function during TPN were 23.8∼54.3%. However, the liver function abnormalities that developed during short term-TPN were reversible and not serious.
키워드
경정맥 영양요법; 간기능 이상; Total parenteral nutrition; Abnormalities of liver function;
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