加ω-3脂肪酸全肠外营养对肠梗阻术后患者肠黏膜屏障功能的影响

Effects of ω-3 fatty acids supplemented total parenterai nutrition supporting on intestinal mucosal barrier in patients with intestinal obstruction after operation

目的探讨加ω-3脂肪酸全肠外营养支持对肠梗阻术后肠黏膜屏障功能的影响。方法将75例肠梗阻术后患者随机分为试验组（38例）和对照组（37例）。两组患者术后开始接受5天的静脉营养支持。试验组补充ω-3脂肪酸注射100ml／d，其余热量用20％中长链混合脂肪乳剂补充。对照组脂肪乳剂的补充全部采用20％中长链混合脂肪乳剂；检测对照组及试验组治疗前1天，治疗后第5天血浆D哥L酸、二胺氧化酶（DAO）水平。检测术后第5天白蛋白，C反应蛋白，记录术后排气、排便时间和住院时间。结果试验组治疗后血浆DAO活性、D-乳酸均显著低于治疗前，差异有统计学意义（P〈0．05），对照组治疗后血浆及DAO活性及D哥L酸与治疗前比较差异无统计学意义（P〉0．05）。治疗后试验组DAO活性、D-乳酸低于对照组（P〈0．05）。术后第5天C反应蛋白、通气、排便时间和住院时间均显著低于对照组，差异有统计学意义（P〈0．05）。结论加ω-3脂肪酸全肠外营养支持有助于保护肠梗阻术后肠道黏膜上皮，降低肠黏膜的通透性。

Objective To evaluate the effects of ω-3 fatty acids supplemented total parenteral nutrition（TPN） supporting on intestinal mucosal barrier in patients with intestinal obstruction after operation. Methods Seventy-five patients with intestinal obstruction after operation were randomly divided into experimental group（38 patients）and control group（ 37 patients）. All patients were treated with routine treatment combined with TPN for 5 days. The patients in control group were treated with 20% medium and long chain fat emulsion,those in experimental group received 100 ml of ω-3 fatty acids additionally. The plasma concentrations of D-lactate, Diamine Oxidase （DAO）were detected by spectro-photography at the first day before surgery and the fifth day after surgery. The plasma albumin （Alb）, C reactive protein （CRP） at the fifth day after surgery, the time of passing gas or stool, hospital stay were analyzed and recor- ded. Results The levels of D-lactate, DAO in experimental group after treatment decreased significantly than before（P 〈 0.05）, while there was no obvious difference before and after treatment in control group （ P 〉 0.05）. After treatment those parameters in experimental group were significantly lower than those in control group（ P 〈 0.05 ）. There were significant differences between two groups（ P 〉 0.05 ）in postoperative CPR level,time of passing gas or stool and hospital stay. Conclusion ω-3 fatty acids supplemented TPN can protect intestinal mucosa epithelium in patients with intestinal obstruction after operation and reduce the permeability of intestinal mucosa.