中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2014年
3期
162-166
,共5页
腹部大手术%营养风险筛查%鱼油脂肪乳%炎性介质%并发症
腹部大手術%營養風險篩查%魚油脂肪乳%炎性介質%併髮癥
복부대수술%영양풍험사사%어유지방유%염성개질%병발증
Major abdominal surgery%Nutritional risk screening%Fish oil intralipid%Inflammatory mediators%Complications
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24 h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 =0.001),非感染性并发症发生率的差异无统计学意义(P=1.000).结论 腹部大手术后有营养风险患者早期TNF-α和IL-6水平显著增加;鱼油能显著降低腹部大手术后有营养风险患者TNF-α的水平;鱼油使腹部大手术后有营养风险患者的并发症发生率显著降低,其中以感染性并发症降低为主.
目的 探討魚油榦預對腹部大手術後有營養風險患者炎性介質及併髮癥的影響.方法 選取2010年9月至2011年3月昆明醫科大學第二附屬醫院普通外科收住院的膽道探查±左肝外葉切除術和胃腸腫瘤根治術,且術後噹日營養風險篩查2002≥3分的患者60例,按手術類彆分為魚油組30例和對照組30例.術後兩組患者均採用等熱量、等氮量的3L袋全胃腸外營養治療,其餘電解質、維生素和微量元素等根據檢測結果進行調整.腸外營養使用不少于5d,其他治療按診療常規進行.所有患者均在全痳下行開腹手術.術前統一放置尿管,併于術後24 h內拔除.兩組患者于手術後噹日進行手術創傷程度評分,併分彆于術前1d,術後1、6d空腹抽取外週靜脈血測定白細胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)水平,記錄相關併髮癥.魚油組有2例在術後第3天選擇退齣研究.結果 魚油組術前1d、術後第1、6天檢測IL-6分彆為(10.65 ±4.24)、(29.45 ±9.39)、(13.37 ±6.99) ng/L,TNF-α分彆為(2.47±1.16)、(23.05±11.43)、(6.05±2.97) ng/L;對照組術前1d、術後第1、6天檢測IL-6分彆為(11.17 ±4.67)、(25.10 ±10.13)、(17.38±7.13) ng/L,TNF-α分彆為(2.70±1.63)、(22.11±12.54)、(8.93 ±3.61) ng/L.術前1d、術後1d兩組IL-6及TNF-α比較差異無統計學意義(P =0.787,P=0.206,P=0.983,P=0.852),術後第6天IL-6兩組比較差異無統計學意義(P =0.101),但魚油組術後第1～6天降低幅度與對照組相比差異有統計學意義(P =0.036).術後第6天兩組TNF-α比較差異有統計學意義(P =0.024).魚油組齣現併髮癥3例(感染性併髮癥2例),對照組為6例(感染性併髮癥5例),併髮癥髮生率的差異有統計學意義(P =0.002),其中感染性併髮癥髮生率的差異有統計學意義(P =0.001),非感染性併髮癥髮生率的差異無統計學意義(P=1.000).結論 腹部大手術後有營養風險患者早期TNF-α和IL-6水平顯著增加;魚油能顯著降低腹部大手術後有營養風險患者TNF-α的水平;魚油使腹部大手術後有營養風險患者的併髮癥髮生率顯著降低,其中以感染性併髮癥降低為主.
목적 탐토어유간예대복부대수술후유영양풍험환자염성개질급병발증적영향.방법 선취2010년9월지2011년3월곤명의과대학제이부속의원보통외과수주원적담도탐사±좌간외협절제술화위장종류근치술,차술후당일영양풍험사사2002≥3분적환자60례,안수술유별분위어유조30례화대조조30례.술후량조환자균채용등열량、등담량적3L대전위장외영양치료,기여전해질、유생소화미량원소등근거검측결과진행조정.장외영양사용불소우5d,기타치료안진료상규진행.소유환자균재전마하행개복수술.술전통일방치뇨관,병우술후24 h내발제.량조환자우수술후당일진행수술창상정도평분,병분별우술전1d,술후1、6d공복추취외주정맥혈측정백세포개소-6(IL-6)、종류배사인자-α(TNF-α)수평,기록상관병발증.어유조유2례재술후제3천선택퇴출연구.결과 어유조술전1d、술후제1、6천검측IL-6분별위(10.65 ±4.24)、(29.45 ±9.39)、(13.37 ±6.99) ng/L,TNF-α분별위(2.47±1.16)、(23.05±11.43)、(6.05±2.97) ng/L;대조조술전1d、술후제1、6천검측IL-6분별위(11.17 ±4.67)、(25.10 ±10.13)、(17.38±7.13) ng/L,TNF-α분별위(2.70±1.63)、(22.11±12.54)、(8.93 ±3.61) ng/L.술전1d、술후1d량조IL-6급TNF-α비교차이무통계학의의(P =0.787,P=0.206,P=0.983,P=0.852),술후제6천IL-6량조비교차이무통계학의의(P =0.101),단어유조술후제1～6천강저폭도여대조조상비차이유통계학의의(P =0.036).술후제6천량조TNF-α비교차이유통계학의의(P =0.024).어유조출현병발증3례(감염성병발증2례),대조조위6례(감염성병발증5례),병발증발생솔적차이유통계학의의(P =0.002),기중감염성병발증발생솔적차이유통계학의의(P =0.001),비감염성병발증발생솔적차이무통계학의의(P=1.000).결론 복부대수술후유영양풍험환자조기TNF-α화IL-6수평현저증가;어유능현저강저복부대수술후유영양풍험환자TNF-α적수평;어유사복부대수술후유영양풍험환자적병발증발생솔현저강저,기중이감염성병발증강저위주.
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 extrahepatic 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 TheIL-6 levels were (10.65 ± 4.24),(29.45 ± 9.39),and (13.37 ± 6.99) ng/Land 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 ± 3.61) ng/L at the corresponding time points.Comparisons of the IL-6 and TNF-α between the fish oil group and control group showed no significant difference one day before surgery and one day after surgery (P =0.787,P =0.206,P =0.983,P =0.852).Comparison of the IL-6 between the one day and six days after surgery also had no statistical significance (P =0.101).However,the decrease of IL-6 was significantly larger in the fish oil group than in the control group from day 1 to day 6 after surgery (P =0.036).The post-operative levels of TNF-α were significantly different between these two groups (P =0.024).Complications were noted in 3 cases (2 cases of infectious complications) in the fish oil group and in 6 cases in the control group (5 cases of infectious complications) (P =0.002),in which the inffectious complications were also statistically significant (P =0.001).Conclusions Patients at nutritional risks after major abdominal surgeries have higher TNF-α and IL-6 levels.Fish oil can notably reduce the TNF-α level in these patients.In addition,fish oil decreases the surgical complications,in particular the infectious complications.
