ω-3多不饱和脂肪酸在颅脑外伤并发肺部感染治疗中的应用

目的：观察ω-3多不饱和脂肪酸（ω-3 PUFAs）在重度颅脑外伤并发肺部感染治疗中的应用效果.方法：将56例重度颅脑外伤并发肺部感染的患者随机分为对照组（A组）和ω-3 PUFAs组（B组）,B组治疗中加用ω-3 PUFAs.2组患者均完善相关检查,给予抗感染、脱水降颅压等常规治疗,均建立人工气道（气管插管或气管切开）及机械通气,给予能量补充105~125 kJ·kg-1·d-1,其中B组中部分热量由含ω-3脂肪酸的脂肪乳剂来提供.分别于治疗前及治疗第2、4、7天监测患者当天白细胞计数、C反应蛋白、淋巴细胞亚群分类,并使用ELISA法检测肺泡灌洗液中肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6及IL-10的水平.结果：肺泡灌洗液中TNF-α的表达水平在第4、7天B组均明显低于A组（P〈0.01）.肺泡灌洗液中IL-6的表达水平在第7天B组显著低于A组（P〈0.01）.肺泡灌洗液中IL-10的表达水平差异无统计学意义（P〉0.05）.白细胞水平在第4、7天B组均低于A组（P〈0.01）.CRP水平在第2、4、7天B组均低于A组（P〈0.01）.CD4/CD8比值在第2、4、7天B组均高于A组（P〈0.01）.结论：ω-3aPUFAs能够调节重度颅脑外伤并发肺部感染患者的免疫状态,对肺脏有一定保护作用.

Role of ω-3 polyunsaturated fatty acids in treatment of severe brain injury accompanied by lung infection

Objective：To observe the effect of ω-3 polyunsaturated fatty acids in treatment of severe brain injury complicated by lung infection. Methods：Fifty-six cases of severe brain injury accompanied by pulmonary infection were randomly divided into control group （group A） and ω-3 polyunsaturated fatty acids group（ group B ）. Group B were administered ω-3 polyunsaturated fatty acids in addition to the routine therapy. All the patients were given relevant examinations and treatment such as antibiotics, reducing the intracranial pressure ,endotracheal intubation,ventilator application and post-tracheotomy. Both groups were given energy supplement 105 - 125 kJ . kg^- 1 . d^-1, but in group B, some of the heat was provided by the fat emulsion of ω-3 polyunsaturated fatty acids. On the 0th ,2nd ,4th and 7th day, the patients＇ white blood cell （WBC）, C reactive protein （CRP） and lymphocyte subsets classification were monitored;and the tumor necrosis factor-α（ TNF-α）, interleukin-6（IL-6） and IL-10 were tested in the lavage fluid by enzyme linked immunosorbent assay. Results：The expression of TNF-α in the lavage fluid of group B on the 4th and 7th day was significantly lower than that of the control group（P 〈0.01 ） ;the expression of IL-6 in the lavage fluid of group B on the 7th day was significantly lower than that of the control group（P 〈 0. 01 ） ;the expression of IL-10 in the lavage fluid of the two groups was not statistically different （P 〉 0.05 ）. The WBC level of group B on the 4th and 7th day was significantly lower than that of the control group （P 〈 0.01 ） ;the CRP level of group B on the 2nd,4th and 7th day was significantly lower than that of the control group（P 〈0.01 ） ;the CD4/CD8 ratio of group B on the 2nd ,4th and 7th day was significantly higher than that of the control （ P 〈 0. 01 ）. Conclusions： ω-3 polyunsaturated fatty acids can improve the immunity of patients with severe brain injury complicated by lung infection and have a protective effect on the lung.