ω-3脂肪乳剂用于危重患者肝功能损伤的临床研究

The clinical study of omega-3 fat emulsion for critically ill patients with liver function damage

目的研究ω-3脂肪乳剂在危重患者肝功能损伤治疗中的应用价值。方法 56例合并肝功能损伤的危重患者随机分为治疗组和对照组,治疗组治疗中应用ω-3脂肪乳剂,对照组应用非ω-3脂肪乳剂。分别于治疗第0、1、4、7天监测患者当日最高体温、呼吸频率、心率和氧合指数,并使用酶联免疫吸附方法(ELISA)检测血中TNF-α、IL-6及IL-10水平,并统计两组患者的肝功能指标(ALT、AST、TBIL、γ-GT)、预后指标(ARACHEⅡ评分、ICU时间、住院时间、28 d病死率)。结果治疗后4 d、7 d对照组的呼吸频率、心率高于治疗组(P<0.05);治疗后7 d对照组的体温高于治疗组(P<0.05);治疗后4 d、7 d对照组氧合指数低于治疗组(P<0.05);治疗后1 d、4 d、7 d治疗组的血TNF-α、IL-6和IL-10均低于对照组(P<0.05);治疗后1 d、4 d、7 d治疗组的血ALT、AST均低于对照组(P<0.05);治疗后4 d、7 d治疗组的血TBIL和γ-GT均低于对照组(P<0.05)。治疗后,两组ARACHEⅡ评分均降低,治疗后7 d治疗组的APACHEⅡ评分低于对照组(P<0.05);对患者的预后随访发现两组的ICU时间、住院时间、28 d病死率差异无统计学意义(P>0.05)。结论ω-3脂肪乳剂能改善合并有肝功能损伤的危重患者的机体免疫状态,减轻炎症反应,对肝脏有一定的保护作用,具有较好的临床应用价值。

Objective To study the application value of omega-3 fat emulsion in treatment of critically ill patients with liver function damage. Methods Fifty-six critically ill patients with liver function injury were randomly divided into treatment group and control group; patients in treatment group were treated with omega-3 fat emulsion. In the treatment of 0, 1, 4, 7 days, respectively, the highest temperature, breathing rate, heart rate and oxygenation index were monitored, the levels of blood TNF-α, IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay （ELISA） and liver function index （ALT, AST, TBIL） , prognostic indicators （ARACHE lI score, length of ICU stay and length of hospital stay, 28-day mortality were detected. Results The breathing rate and heart rate in the control group were higher than those in the treatment group after treatment of 4 days and 7 days, while the oxygenation index was lower than that in the treatment group （P 〈 0.05） , the temperature was lower than that in the treatment group after treatment of 7 clays （P 〈0.05）. after treatment of 1 day, 4 days and 7 days, the levels of blood TNF-α, IL-6 and IL-10 in treatment group were lower than those in control group （P 〈 0. 05） ; after treatment of 1 day, 4 days and 7 days, the levels of ALT and AST in treatment group were lower than those in the control group （P 〈 0. 05） , and the TBIL and y-GT blood levels in treatment group were lower than those in control group after treatment of 4 days and 7 days （P 〈 0.05 ）. APACHE II score in treatment group was lower than the that in control group after treatment of 7 days （P 〈 0.05）. The difference of lengths of ICU stay and hospital stay and 28-day mortality rate were not statistically significant between two groups （P 〉 0. 05）. Conclusion The omega-3 fat emulsion can improve the immune status of critically ill patients with liver function damage, reduce inflammation, and protect the liver to a certain extent, which has good clinical application value.