胃癌患者术前应用含ω-3不饱和脂肪酸的肠内营养制剂的临床效果观察

Clinical Effect of Preoperative Administration of Enteral Nutrition Enriched ω-3 Fatty Acids for Gastric Cancer

目的探讨术前应用含ω-3不饱和脂肪酸的肠内营养制剂对胃癌患者营养状况和炎症因子水平的影响,并对其进行安全性评价。方法前瞻性纳入2014年1~6月期间四川大学华西医院收治的60例胃癌患者,随机分为试验组（30例）和对照组（30例）。试验组术前以含ω-3不饱和脂肪酸的营养制剂（瑞能）作为肠内营养制剂,对照组进食等热卡等氮的均浆膳,术前均连续服用5 d,至术前1 d。检测患者入院时、术前1 d、术后3 d及术后5 d血清中的炎症因子指标和营养相关指标,检测患者入院时和术前1 d的肝肾功能指标以作为安全性评价指标;记录患者呕吐、腹泻等不良反应,以及术后感染相关并发症的发生情况。结果术后3 d试验组患者的白介素-6（IL-6）和α-1酸性糖蛋白（AAG）水平均低于对照组（P〈0.05）,术后5 d试验组的C反应蛋白（CRP）水平低于对照组（P〈0.05）,其余各时点2组患者的各指标比较差异均无统计学意义（P〉0.05）。在肠内营养支持期间,试验组患者发生腹胀1例,腹泻1例,对照组患者未出现腹胀、腹泻等不适。2组患者的不良反应发生率比较差异无统计学意义（P〉0.05）。术后试验组发生切口感染1例（3.3%）;对照组发生切口感染3例（10.0%）,腹腔感染1例（3.3%）,尿路感染1例（3.3%）,肺部感染2例（6.7%）,共计7例（23.3%）。2组患者的腹腔感染、切口感染、尿路感染及肺部感染发生率比较差异均无统计学意义（P〉0.05）,但试验组的总并发症发生率低于对照组（P=0.026）。结论术前应用含ω-3不饱和脂肪酸的营养制剂降低了胃癌患者术后的感染并发症发生率,且安全性较高。

Objective To evaluate the safety and efficacy of preoperation administration of enteral nutrition enriched ω-3 fatty acids for gastric cancer patients. Methods A single center randomized controlled clinical trial was performed in 60 cases of gastric cancer in West China Hospital during January 2014 to June 2014, and cases were equally randomized divided into treatment group and control group. Cases of treatment group were given enteral nutrition enriched ω-3 fatty acids which was manufactured by Fresenius Kabi Deutschland Gmb H for 5 consecutive days before operation, and cases of control group were given an isocaloric and isonitrogenous homogenized diet for 5 consecutive days before operation. The laboratory indexes of nutritional status and imflammatory factors were observed and compared between 2 groups on admission, preoperative day 1, postoperative day 3, and postoperative day 5. Liver and kidney function indexes which as the safety indexes were detected on admission and preoperative day 1. Vomiting, diarrhea,and infectious complications were recorded in addition. Results On 3 days after operation, levels of interleukin-6（IL-6） and α-acid glycoprotein（AAG） of treatment group were both lower than those of control group（P〈0.05）; on 5 days after operation, levels of C-reactive protein（CRP） of treatment group was lower than that of control group too（P〈0.05）; but at other time points, there were no significant differences in any index between the 2 groups（P〉0.05）. During the period of enteral nutrition, only 1 case suffered from bloating and 1 case suffered from diarrhea, both in treatment group, and the incidence of adverse reactions didn’t differed between treatment group 〔6.7%（2/30）〕 and control group 〔0（0/30）〕, P〉0.05. Moreover, there were no significant differences between treatment group and control group in incidences of wound infection 〔3.3%（1/30） vs. 10.0%（3/30）〕, abdominal infection 〔0（0/30） vs. 3.3%（1/30）〕, urinary infection 〔0（0/30） vs. 3.3%（1/30）〕, and pulmonary infection 〔0（0/30） vs. 6.7%（2/30）〕, but the total incidence of complication was lower in treatment group than that of control group 〔3.3%（1/30） vs. 23.3%（7/30）〕, P=0.026. Conclusion Enteral nutrition enriched ω-3 fatty acids can reduce the rate of infection-related complication for patients with gastric cancer, and has a sense of safety.