食管癌患者术后应用不同剂量ω-3多不饱和脂肪酸的临床效果观察

Clinical effect of different dose of ω-3 polyunsaturated fatty acids in postoperative patients with esophagus cancer

目的探讨术后早期应用不同剂量ω-3多不饱和脂肪酸对食管癌患者炎症因子、营养状况以及术后并发症的影响。方法将92例食管癌患者按随机数字表法分为对照组32例、实验1组30例和实验2组30例。所有患者术后均给予6d肠外营养支持治疗,胃肠功能恢复后给予流食。对照组另外给予生理盐水100 mL/d,实验1组给予ω-3鱼油脂肪乳注射液50mL/d和生理盐水50mL/d,实验2组给予ω-3鱼油脂肪乳注射液100 mL/d,疗程均为1周。收集并比较3组术前1d、术后1d、术后7d降钙素原(procalicitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、白蛋白(albumin,Alb)、淋巴细胞(lymphocyte,LYM)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,TFN)含量,记录药物不良反应及术后并发症发生情况。结果术后7d时,实验1组和实验组2组PCT、CRP和IL-6水平均低于对照组(P<0.05),3组PCT、CRP和IL-6组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05),实验2组PCT、CRP和IL-6水平均低于实验1组(P<0.05),实验1组和实验组2组LYM高于对照组(P<0.05),实验2组LYM高于实验1组(P<0.05)。对照组发生切口感染3例,肺部感染3例,吻合口瘘1例;实验1组发生切口感染3例,肺部感染3例;实验2组发生切口感染1例。实验2组并发症发生率3.33%(1/30)低于对照组21.88%(7/32)和实验1组20.00%(6/30)(χ2=4.737、4.043,P=0.030、0.044),实验1组与对照组并发症发生率差异无统计学意义(χ2=0.033,P=0.856)。结论ω-3多不饱和脂肪酸能够减轻食管癌患者术后炎症反应,一定程度上改善患者术后营养状态,大剂量应用不仅效果更为明显,且能够降低患者术后并发症发生率。

Objective To investigate the effect of different doses ofω-3polyunsaturated fatty acid on inflammatory factors,nutritional status and postoperative complications in patients with esophageal carcinoma.Methods Ninety-two patients wtih esophagus cancer were randomly divided into a control group（32cases）,experimental group 1（30cases）and the experimental group 2（30cases）.All patients were given 6days of parenteral nutrition support treatment,and then were given liquid diet after recovery of gastrointestinal function.Control group was given saline 100 mL/d,the experimental group 1 were treated with saline 50 mL/d and ω-3polyunsaturated fatty acid 50 mL/d,the experimental group 2 were treated with ω-3polyunsaturated fatty acid 100 mL/d,all the treatment course was one week.Procalicitonin（PCT）,C-reactive protein（CRP）and interleukin-6（IL-6）,albumin（Alb）,lymphocyte（LYM）,prealbumin（PA）and transferrin（TFN）of patients were collected and compared on preoperative day 1,postoperative day 1,and postoperative day 7.The drug reactions and the occurrence of postoperative complications were recorded.Results On postoperative day 7,the PCT,CPR and IL-6of experimental group 1and experimental group 2 were lower than that of conrol group（P 0.05）,the PCT,CPR and IL-6 of experimental group2 were lower than that of experimental group 1（P〈0.05）,the LYM of experimental group 1and experimental group 2were higher than that of conrol group（P〈0.05）,the LYM of experimental group 2were higher than that of experimental group 1（P〈0.05）.There were 3cases of wound infection,2cases of pulmonary infection,1cases of anastomotic leakage in control group,3cases of wound infection in experimental group 1,3cases of pulmonary infection and 1cases of incision infection in experimental group 2.The incidence of complications was 3.33%（1/30）in experimental group 2,which was lower than that in control group 21.88%（7/32）and the experimental group 2（P〈0.05）.The incidence of complications were not statistically significant（P〈0.05）.Conclusion ω-3polyunsaturated fatty acids can reduce the inflammatory reaction in patients with esophageal cancer,and improve the nutritional status of patients after surgery.The application of large dose is more obvious,and can reduce the incidence of postoperative complications.