ω-3多不饱和脂肪酸对腹部脓毒症患者的临床疗效

Clinical effect of ω-3 polyunsaturated fatty acid on patients with abdominal sepsis

目的观察ω-3多不饱和脂肪酸(ω-3PUFA)对腹部脓毒症患者临床治疗效果。方法选择腹部脓毒症患者53例,随机分为对照组(28例)和研究组(25例),对照组给予常规的全肠外营养(TPN),研究组除常规的TPN外,在营养配方中添加ω-3PUFA(0.2g·kg-1·d-1)连续5天,分别于TPN治疗前及治疗后第3、6天测定两组患者外周血白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、D-乳酸、白蛋白(ALB)、前白蛋白(PA)的水平,采动脉血计算氧合指数(OI),急性生理学和慢性健康状况评分系统(APACHEⅡ)评分,同时记录重症监护病房(ICU)住院时间、机械通气和持续血液滤过治疗例数及应用时间。结果治疗后第3、6天,研究组WBC、CRP、ALB、PA、PCT、D-乳酸及OI水平均较对照组显著改善(P<0.05);研究组ICU住院时间显著低于对照组10.03(2.15)天vs 7.75(1.90)天(P<0.05),APACHEⅡ评分、机械通气与持续血液滤过治疗的例数及时间较对照组有下降趋势,但差异无统计学意义(P>0.05)。结论ω-3PUFAs免疫增强的肠外营养,能改善腹部脓毒症患者的营养及器官功能,减轻炎性反应,缩短住院时间,是一种有效的腹部脓毒症营养治疗方案。

Objective To observe the clinical effect of ω-3 polyunsaturated fatty acid（ω-3PUFAs）on patients with abdominal sepsis.Methods Fifty-three patients with abdominal sepsis were randomly divided into routine total parenteral nutrition group （control group,28 cases）and ω-3 polyunsaturated fatty acid＋TPN （study group,25 cases）. All patients received the same basic treatment and TPN with equal nitrogen content and calories,and the ω-3PUFAs （0.2 g＆#183;kg-1 ＆#183;d-1 ）was added to study group for five days.The concentrations of serum white blood cell（WBC）,C-reactive protein（CRP）,procalcitonin（PCT）,D-blood lactate,albumin（ALB）,prealbumin（PA）,oxygennation index（OI） were detected and the scores of Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ）were computed before and after the treatment 3,6 days,respectively.The length of stay in ICU,mechanical ventilation time and continuous hemofiltration treatment time were compared.Results Compared with the control group,the concentrations of serum WBC,CRP,ALB,PA,PCT,D-blood lactate,and OI were significantly improved in study group after the treatment 3,6 days（P 〈0.05）.The length of stay in ICU was shorter in study group than that in control group 10.03[2.1 5]days vs （7.75 [1.90 ]） days （P 〈 0.05 ）.No statistical difference was found in the scores of APACHE Ⅱ,mechanical ventilation time or continuous hemofiltration treatment time （P 〉 0.05 ）.Conclusion ω-3PUFAs can improve the nutritional condition,reduce inflammatory reaction and the length of stay in ICU.ω-3PUFAs may be an effective immunological nutritional therapy for patients with abdominal sepsis.