摘要
目的探讨鱼油干预对腹部大手术后有营养风险患者炎性介质及并发症的影响。方法选取2010年9月至2011年3月昆明医科大学第二附属医院普通外科收住院的胆道探查＋左肝外叶切除术和胃肠肿瘤根治术，且术后当日营养风险筛查2002≥3分的患者60例，按手术类别分为鱼油组30例和对照组30例。术后两组患者均采用等热量、等氮量的3L袋全胃肠外营养治疗，其余电解质、维生素和微量元素等根据检测结果进行调整。肠外营养使用不少于5d，其他治疗按诊疗常规进行。所有患者均在全麻下行开腹手术。术前统一放置尿管，并于术后24h内拔除。两组患者于手术后当日进行手术创伤程度评分，并分别于术前1d，术后1、6d空腹抽取外周静脉血测定白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平，记录相关并发症。鱼油组有2例在术后第3天选择退出研究。结果鱼油组术前1d、术后第1、6天检测IL-6分别为（10．65±4．24）、（29．45±9．39）、（13．37±6．99）ng／L，TNF-α分别为（2．47±1．16）、（23．05±11．43）、（6．05±2．97）ng/L；对照组术前1d、术后第1、6天检测IL-6分别为（11．17±4．67）、（25．10±10．13）、（17．38±7．13）ng／L，TNF-α分别为（2．70±1．63）、（22．11±12．54）、（8．93±3．61）ng／L。术前1d、术后1d两组IL-6及TNF-α比较差异无统计学意义（P=0．787，P=0．206，P=0．983，P=0．852），术后第6天IL-6两组比较差异无统计学意义（P=0．101），但鱼油组术后第1—6天降低幅度与对照组相比差异有统计学意义（P=0．036）。术后第6天两组TNF-α比较差异有统计学意义（P=0．024）。鱼油组出现并发症3例（感染性并发症2例），对照组为6例（感染性并发症5例），并发症发生率的差异有统计学意义（P=0．002），其中感染性并发症发生率的差异有统计学意义（P=0．
Objective To explore the change of complications and inflammatory mediators in patients at nutritional risk after intervention with fish oil after major abdominal surgery. Methods Totally 60 patients who had received extrahepatie bile duct exploration ± left lobectomy and radical surgeries for their gastrointestinal tumors in our department from September 2010 to March 2011 were enrolled in this study. Their Nutritional Risk Screening 2002 scores were ≥3 points the day after surgery. These 60 cases patients were randomly divided into fish oil group （ n = 30） and the control group （ n = 30 ）. Both groups were treated with total parenteral nutrition isocaloric and isonitrogenous energy emulsion intralipid of 3 Ls＇ bags after surgery. Aslo, they were treated with electrolyte, vitamins and trace elements equally, which were adjusted according to laboratory tests. The application of parenteral nutrition was no less than 5 days, and the other treatment was provided routinely. Surgeries were performed under general anesthesia in all patients. Urinary catheter was uniformly placed preoperative, and was removed within 24 hours after surgery. The degree of surgical trauma was scored on the operative day. Fasting venous blood samples were collected for measuring the fasting interleukin （IL）-6 and tumour necrosis factor-α （TNF-α） one day before surgery and one and six days after surgery. The relevant complications were recorded. Two patients in the fish oil group withdrew from the study on the third post-operative day. Results The IL-6 levelswere （10.65 ± 4.24）, （29.45 ± 9.39）, and （13.37 ± 6.99） ng/L and the TNF-α levels were （2.47 ± 1.16）, （23.05 ± 11.43）, and （6. 05 ± 2.97） ng/L in the fish oil group one day before surgery and one and six days after surgery. In the control group, in contrast, the IL-6 levels were （11.17 ± 4.67）, （25.10 ± 10. 13）, and （17.38 ± 7.13） ng/L and the TNF-α levels were （2.70 ± 1.63）, （22. 11 ± 12. 54）, and （8. 93 �
出处
《中华临床营养杂志》
CAS
CSCD
2014年第3期162-166,共5页
Chinese Journal of Clinical Nutrition
关键词
腹部大手术
营养风险筛查
鱼油脂肪乳
炎性介质
并发症
Major abdominal surgery
Nutritional risk screening
Fish oil intralipid
Inflammatory mediators
Complications
