富含鱼油脂肪乳的全胃肠外营养对全身炎症反应综合征患者炎症反应的影响

Effects of fat emulsion made of fish oil for total parenteral nutrition on patients with systemic inflammatory response syndrome

目的探讨鱼油脂肪乳对全身炎症反应综合征（SIRS）患者炎症反应的影响。方法选择2007年1月至2007年6月入住聊城市人民医院重症加强治疗病房（ICU）的SIRS患者40例，随机分为常规胃肠外营养（TPN）组（A组，20例）和鱼油脂肪乳＋TPN治疗组（B组，20例）。两组患者均接受等氮、等热量的TPN。患者所需热量按20kcal／（ks·d），1kcal=4．1868kJ，氮入量0．2g／（kg·d）。B组加用鱼油脂肪乳（商品名：尤文，批号UK1580，中国无锡华瑞制药有限公司生产）1-2ml／（kg·d），共7d。治疗前及治疗后1d、3d和7d分别检测血清肿瘤坏死因子-α（TNF-α）、白细胞介素．1（IL-1）、IL-6的浓度。统计两组患者住ICU时间，MODS发生例数及28d死亡例数。所有数据采用SPSS10．0进行统计学处理。结果两组患者APACHE-Ⅱ评分差异无统计学意义，与常规TPN治疗组比较，加用鱼油脂肪乳治疗后不同时间点血清TNF-α、IL-1、IL-6差异均有统计学意义（P〈0．05或P〈0．01）；住ICU天数明显缩短，差异有统计学意义[（11．5±2．4）d比（15．8±2．3）d，P〈0．05]，MODS发生例数及28d病死例数均明显少于对照组。结论鱼油脂肪乳可降低SIRS患者TNF-α、IL-1、IL-6的水平，从而达到阻断SIRS向MODS转化的作用，减少MODS的发生，缩短住ICU时间，提高危重患者抢救成功率。

Objective To explore the effects of fat emulsion made of fish oil for total parenteral nutrition on patients with systemic inflammatory response syndrome （SIRS）. Method Forty patients with SIRS in the intensive care unit （ICU）, Liaocheng People＇s Hospital, from January to June 2007 were randomly divided into conventional total parenteral nutrition （TPN） group （group A, n = 20） and fish oil emulsion ＋ TPN group （group B, n = 20）. Patients of both groups received equal amount of nitrogen and calories. The energy given was 20 kcal/（kg.d）, and nitrogen 0.2 g/（kg.d） for 7 days and the fish oil emulsion given was 1 - 2 ml/（kg.d）（Com- moditieds： Omegaven,No. UK 1580,Wuxi, China SINO-SWEO Pharmaceutical CORP. Ltd. ）. The levels of serum TNF-α,IL-1 and IL-6 were checked before TPN and 1 d,3 d and 7 d after TPN. The days of ICU stay, the incidence of MODS and the mortality within 28 days of two groups were also recorded. Data were analyzed with inde- pent-samples t test and paired-samples t test using the SPSS 10.34 software. Results There was no significant difference in APACHE- Ⅱ score between two groups of patients. Compared with group A, the levels of serum TNF-α, IL- 1 and IL-6 in group B decreased markedly at different intervals （ P 〈 0.05, P 〈 0.01）. The duration of ICU stay shortened obviously in group B than that in group A [ （11.5 ± 2.4）days vs. （15.8± 2.3）days, P 〈 0.05 ]. Conclusions The fat emulsion made of fish oil has protective effects on patients with SIRS by the mechanism of decrease in the levels of serum TNF-α, IL-1 and IL-6, and thereby reduces the incidence of MODS, shortens the duration of ICU stay, increasing the survival rate of seriously ill patients.