ω-3脂肪酸对腹部手术后患者炎性反应、免疫功能和临床结局的影响

Impact of fish oil emulsion on immune function,SIRS and outcome after abdominal major surgery

目的评价添加ω-3脂肪酸的肠外营养对腹部手术后患者炎性反应、免疫功能和临床结局指标的影响。方法采用前瞻、随机、双盲和对照的方法 ,40例接受腹部大手术的患者进入本研究;术后1～7天给予全肠外营养,其中葡萄糖3 g/(kg·d),脂肪1.2 g/(kg·d),氮入量0.2g/(kg·d);对照组(20例)肠外营养中给予大豆油长链脂肪乳;研究组(20例)用鱼油脂肪乳[0.2g/(kg·d)]替代部分大豆油脂肪乳;观察细胞免疫指标(CD4、CD8、CD4/CD8)、炎性反应因子(IL-6和TNF-α)的变化;记录系统性炎性反应综合征(SIRS)和临床结局指标(并发症、感染性并发症、住院天数和费用等)。结果 40例患者均完成研究,无脱落病例;入组患者的一般资料具有可比性;接受7天全肠外营养后,将术后第8天与术后第1天细胞免疫指标和炎性因子的变化结果进行分析发现,研究组CD4的升高幅度为(13.1%±9.8%),多于对照组(4.2%±10.1%);研究组CD4/CD8升高较对照组显著,分别为(0.48±0.41)和(0.12±0.38)。研究组IL-6下降了(-29.8±26.8)ng/L,低于对照组[(-14.1±14.8)ng/L];TNF-α在术后第8天,研究组下降幅度多于对照组,分别为(1.59±1.44)ng/L,(-0.02±1.21)ng/L。研究组发生感染性并发症少于对照组(2例比5例);研究组发现SIRS病例少于对照组(2例比8例);研究组术后总的并发症、住院时间和总医疗费用相似。结论添加鱼油脂肪乳的肠外营养能改善患者腹部大手术后的免疫功能、减轻炎性因子释放和SIRS发生,可能减少术后感染并发症。

Objective To evaluate the clinical efficacy of a fish oil emulsion on outcome, SIRS and immune function after abdominal major surgery. Methods Total of 40 patients with gastric, colonic cancer or cholelithiasis were randomized to receive isocaloric and isonitrogenous intravenous infusions of either soybean oil alone （ 1.2 g per kg bodyweight per day ; control group, n = 20） or soybean plus fish oil emulsion （ 1.0 and 0.2 g per kg per day respectively; study group, n =20） over 16 to 20 h daily for 7 days after surgery. Results Baseline data were comparable in the two groups. The mean difference of CD4 between POD8 and POD1 was （ 13.1% ±9.8% ） in study group and （4.2% ±10.1% ） in control group （P = 0.008 ） ;CD4/CD8 increased significantly in study group too （0.48 ± 0.41versus 0.12 ± 0.38 in control group,P = 0.006）. IL-6 decreased more in the fish oil group than in the soybean oil group, （ - 29.8 ± 26.8） ng/L and （ - 14.1 ± 14.8 ） ng/L respectively （ P = 0. 028 ） ; The mean difference of TNF-α between POD8 and POD1 was （ 1.59 ± 1.44） ng/L in study group and （ - 0.02 ± 1.21 ） ng/L in control group （ P = 0. 0006 ）. There were more infectious complications （5 versus 2 on day 8 ; P = 0.41 ） and systemic inflammatory response syndrome （SIRS） （8 versus 2 ; P = 0. 029） in the control group. Total postoperative complications, hospital stay and total postoperative medical costs were comparable in the two groups（ all P 〉 0.05 ）. There were no severe adverse events in both groups. Conclusions Fish oil emulsion-supplemented parenteral nutrition significantly improved immune functions and reduced SIRS and might decrease infectious complications.