术前给予ω-3鱼油脂肪酸改善恶性梗阻性黄疸患者预后的效果与机制

Effects and Mechanism of Preoperative Omega-3 Fish Oil Fatty Acid Administration on Prognosis of Patients with Malignant Obstructive Jaundice

目的:探讨术前给予ω-3鱼油脂肪酸改善恶性梗阻性黄疸患者预后的效果与机制。方法:采用回顾性研究方法,选择2015年9月到2018年2月在我院重症监护病房(ICU)诊治的恶性梗阻性黄疸患者72例,根据治疗方法的不同分为研究组40例与对照组32例。两组都给予内镜下逆行胰胆管造影(ERCP)胆道支架(引流)术与常规肠外营养支持,研究组术前5d开始给予口服ω-3鱼油脂肪酸,对照组术前不给予口服ω-3鱼油脂肪酸,记录两组患者术后感染发生情况与预后情况。结果:两组术前5d、术后1d与术后14d的肝功能指标AST和ALT在组内与组间对比差异都无统计学意义(P>0.05)。研究组术后14d的CD4+值显著高于术前5d与术后1d(P<0.05),也显著高于对照组(P<0.05),CD3+值在组内与组间对比差异都无统计学意义(P>0.05)。研究组术后14d的胆道感染、肺部感染、腹腔感染等并发症发生率为5.0%,对照组为25.0%,研究组低于对照组(P<0.05)。研究组术后14d的APACHEⅡ评分低于对照组,住院时间少于对照组(P<0.05)。结论:术前给予ω-3鱼油脂肪酸能降低恶性梗阻性黄疸术后感染的发生,不影响患者的肝功能,能提高患者的免疫功能,促进患者的康复。

Objective:To explore the effects and mechanism of preoperativeω-3 fish oil fatty acid administration on improving the prognosis in patients with malignant obstructive jaundice.Methods:From September 2015 to February 2018,72 patients with malignant obstructive jaundice treated in ICU were selected and were divided intoω-3 fish oil fatty acid group(ω-3 group,n=40)and control group(n=32).Both groups were given ERCP biliary stent(drainage)and routine parenteral nutrition support,and the observation group were given preoperativeω-3 fish oil fatty acid administration for 5 days.The incidence postoperative infection and prognosis between the two groups were compared.Results:There were no statistically significant difference in serum AST and ALT between the two groups at the end of 5 dpreoperation,1 dpostoperation and 14 dpostoperation(all P>0.05).The CD4+counts ofω-3 group at 14 dafter operation were significantly higher than that at 5 dpreoperation and 1 dpostoperation(both P<0.05),and were also signifi-cantly higher than that of control group(P<0.05),and there were no significant difference in the CD3+counts as compared between the two groups(P>0.05).At the end of 14 dafter operation,the incidence of biliary tract infection,lung infection,incision infection and other complications inω-3 group was significant lower than that in the control group(5% vs 25.0%,P<0.05),and the APACHE Ⅱscores and the hospital stays were less inω-3 group than in control group(both P<0.05).Conclusion:The preoperative administration ofω-3 fish oil fatty acid can reduce the incidence of postoperative infection in malignant obstructive jaundice,improve the immune function and promote the recovery of the patients,but it do not affect the liver function of the patients.