添加ω-3鱼油脂肪乳的肠外营养对胃癌术后患者营养、应激及肝功能的影响

Effects of parenteral nutrition supplemented with omega-3 fish oil fat emulsion on nutrition,stress,and liver function in patients with gastric cancer after operation

目的探讨ω-3鱼油脂肪乳在胃癌根治术后肠外营养支持治疗中的应用价值。方法回顾性收集2018年3月到2019年9月期间铜陵市人民医院收治的80例行胃癌根治术患者的临床资料。40例患者术后使用常规肠外营养(对照组),40例患者的术后肠外营养方案中额外添加100 mLω-3鱼油脂肪乳(观察组)。收集的营养和应激指标包括术前1 d,以及术后1、3和7 d的血总白蛋白(TP)、白蛋白(ALB)、C反应蛋白(CRP)和降钙素原(PCT);收集的肝功能指标包括术前1 d,以及术后3 d和7 d的血总胆固醇(CHO)、甘油三酯(TG)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)和γ谷氨酰转肽酶(γ-GT)。结果①营养指标:2组患者术前1 d,以及术后1、3和7 d时的TP和ALB水平比较差异均无统计学意义(P>0.05)。同组内与术前1 d比较,对照组和观察组患者术后1、3及7 d的TP水平均降低(P<0.05);与术前1 d比较,对照组和观察组患者术后1 d的ALB水平降低(P<0.05),术后7 d升高(P<0.05)。②应激指标:2组患者术前1 d和术后1 d的CRP和PCT水平比较差异均无统计学意义(P>0.05);术后3 d和术后7 d时,观察组患者的CRP和PCT水平低于对照组(P<0.05)。与术前1 d的CRP和PCT水平比较,观察组和对照组术后1、3和7 d的CRP和PCT水平均增高(P<0.05)。③肝功能指标:2组患者术前1 d和术后3 d的CHO、TG及γ-GT水平比较差异均无统计学意义(P>0.05),但术后7 d观察组患者的上述指标均低于对照组(P<0.05);2组患者术前1 d、术后1 d和术后3 d的TBIL、ALT和ALP水平比较差异均无统计学意义(P>0.05)。同组内与术前1 d比较,术后各时点观察组和对照组患者的CHO和ALP水平的差异均无统计学意义(P>0.05);同组内与术前1 d比较,术后3 d和7 d时观察组的TG和TBIL水平的差异均无统计学意义(P>0.05),但对照组术后7 d的TG和TBIL水平升高(P<0.05);同组内与术前1 d比较,术后7 d观察组和对照组的ALT和γ-GT水平均升高(P<0.05)。结论添加ω-3鱼油脂肪乳的肠外营养对术后近期营养状况无明显改善,但可减轻胃癌术后患者炎症应激反应,并保护肝功能。

Objective To evaluate the value of omega-3 fish oil fat emulsion in parenteral nutrition support after radical resection of gastric cancer patients.Methods The clinical data of 80 patients in Tongling Peopl’s Hospital undergoing radical resection of gastric cancer from March 2018 to September 2019 were enrolled by retrospective method.Of them,40 patients were treated with routine parenteral nutrition(control group)and 40 patients were treated with extra 100 mL omega-3 fish oil fat emulsion after operation(observation group).Nutritional and stress indicators included blood total albumin(TP),albumin(ALB),c-reactive protein(CRP),and procalcitonin(PCT)on one day before operation,and 1st,3rd,and 7th day after operation were collected.The collected indexes of liver function included blood cholesterol(CHO),triglyceride(TG),total bilirubin(TBIL),alanine aminotransferase(ALT),alkaline phosphatase(ALP),and gamma glutamyl transpeptidase(γ-GT)on one day before operation,and 3rd and 7th days after operation.Results①Nutritional indicator.There was no significant differences in TP and ALB levels between the two groups on one day before operation,and on the 1st,3rd,and 7th day after operation(P>0.05).In the same group compared with one day before operation,the average TP level of the control group and the observation group decreased on the 1st,3rd,and 7th day after operation(P<0.05),and in the control group and the observation group,the ALB level decreased on the 1st day after operation(P<0.05),and increased on the 7th day after operation(P<0.05).②Stress index.There was no significant difference in CRP and PCT levels between the two groups on one day before and one day after operation(P>0.05),and the CRP and PCT levels in the observation group were lower than those in the control group on the 3rd day and 7th day after operation(P<0.05).Compared with the CRP and PCT levels on the one day before operation,the average CRP and PCT levels in the observation group and the control group increased on the 1st,3rd,and 7th day after operation(P<0.05).③Liver function index.There was no significant differences in CHO,TG,andγ-GT levels between the two groups on one day before operation and the 3rd day after operation(P>0.05),but the above indexes of observation group were lower on the 7th day after operation than those of the control group(P<0.05).There was no significant differences on TBIL,ALT,and ALP levels between the postoperative observation group and the control group(P>0.05).Compared with one day before operation in the same group,there was no significant difference on CHO and ALP levels on 3rd and 7th day after operation in both the observation group and control group(P>0.05).There was no significant differences in TG and TBIL levels in the observation group on 3rd and 7th day after operation(P>0.05),but the TG and TBIL levels in the control group were increased on 7th after operation(P<0.05),and the ALT andγ-GT levels in the observation group and the control group on 7th day after operation were increased in the same group compared with one day before operation(P<0.05).Conclusion Parenteral nutrition with omega-3 fish oil fat emulsion do not improve the recent postoperative nutritional status,but reduce the inflammatory stress response and protecte liver function in patients with gastric cancer after operation.