添加n-3脂肪酸的全肠外营养对外科全身炎症反应综合征患者的影响

目的:探讨添加n-3脂肪酸的全肠外营养(TPN)对外科全身炎症反应综合征(SIRS)患者的影响。方法:将48例诊断SIRS的外科危重症患者随机分为实验组(含n-3脂肪酸)和对照组(不含n-3脂肪酸),均给予常规外科治疗及连续TPN 5 d,分别于TPN前1天和后第5天抽取外周静脉血,测量炎症反应指标:C反应蛋白(CRP)、TNF-α、IL-1、IL-6、IL-8;肝脏和胰腺功能:血清天冬氨酸氨基转移酶(ASAT)、丙氨酸氨基转移酶(ALAT)、胆红素(TBIL)、脂肪酶(LPS);并分别进行APACHE评分。结果:所有患者均无不良反应发生,两组CRP、TNF-α、IL-1、IL-6、IL-8、ASAT、ALAT、TBIL、LPS、APACHE评分研究结束时均有改善(P<0.05),但实验组改善优于对照组,差异有显著性(P<0.05)。结论:添加n-3脂肪酸的TPN对SIRS患者在阻断过度炎症反应、保护重要器官功能方面发挥了重要的作用,有利于细胞及器官功能的恢复。

Effects of n-3 fatty acids supplemented total parenteral nutrition support on systemic inflammatory response syndrome in surgical patients

Objective:To evaluate the effect of n-3 fatty acids supplemented total parenteral nutrition(TPN) support on the surgical patients with systemic inflammatory response syndrome(SIRS).Methods:Forty-eight cases surgical patients with SIRS were involved in a randomized controlled prospective clinical trial,and divided into n-3 fatty acids group and control group.All patients were treated with routine surgical treatment combined with TPN.Twenty-four cases in n-3 fatty acids group were treated with n-3 fatty acids supplied by n-3 fatty acids solution 100ml,and another 24 cases in control group were not given.All patients were observed for 5 days.The data about inflammatory parameter and the function of liver and pancreas were analyzed.Results:No side effects were noted.The scores of acute physiology and chronic health evaluation(APACHE Ⅱ) and the level of serum CRP,IL-1,IL-6,IL-8,TNF-α,ASAT,ALAT,TBIL and LPS decreased significantly in two groups(P<0.05),but the decrease in n-3 fatty acids group was more obvious than that in control group(P<0.05).Conclusion:N-3 fatty acids supplemented TPN improves the function of liver and pancreas and relieves the degree of acute inflammatory response of the surgical patients with SIRS,and it benefits to resume the function of cells and organs.