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《中华消化外科杂志》2019年10月第18卷第10期论著

ω-3鱼油脂肪乳在胃癌根治术后肠外营养支持治疗中的应用价值

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引用本文:
单廷,陈义钢,洪波,等.ω-3鱼油脂肪乳在胃癌根治术后肠外营养支持治疗中的应用价值[J].中华消化外科杂志,2019,18(10):960-965.DOI:10.3760/cma.j.issn.1673-9752.2019.10.012.
【摘要】

目的:探讨ω-3鱼油脂肪乳在胃癌根治术后肠外营养支持治疗中的应用价值。
方法:采用回顾性队列研究方法。收集2018年1—12月南京医科大学附属无锡第二医院收治的60例行胃癌根治术患者的临床资料;男37例,女23例;平均年龄为64岁,年龄范围为28~78岁。30例患者胃癌根治术后肠外营养支持治疗添加100 mL ω-3鱼油脂肪乳,设为试验组;30例患者胃癌根治术后肠外营养支持治疗添加常规脂肪乳,设为对照组。观察指标:(1)围术期营养指标检测情况。(2) 围术期炎症反应指标检测情况。(3)围术期免疫学指标检测情况。(4)术后并发症情况。正态分布的计量资料以Mean±SD表示,组间比较采用独立样本t检验,计数资料以绝对数或百分比表示,组间比较采用x检验。重复测量数据采用重复测量方差分析。
结果:(1)围术期营养指标检测情况:试验组患者总蛋白、白蛋白、前白蛋白、转铁蛋白分别由术前1天的(60.2±3.0)g/L、(35.3±3.1)g/L、(186±24)mg/L、(3.0±0.7) g/L变化为术后第6天的(57.2±3.1)g/L、(37.0±1.8)g/L、(172±17)mg/L、(2.4±0.4)g/L,对照组上述指标分别由术前1天的(60.6±2.4)g/L、(35.0±3.8)g/L、(184±18)mg/L、(3.1±0.6)g/L变化为术后第6天的(55.7±4.2)g/L、(36.0±3.8)g/L、(173±25)mg/L、(2.2±0.8)g/L。两组患者上述指标变化趋势比较,差异均无统计学意义(F=0.79,2.14,0.03,0.36,P>0.05)。(2)围术期炎症反应指标检测情况:试验组患者白细胞计数、C反应蛋白、白细胞介素6、肿瘤坏死因子α分别由术前1天的(7.2±1.1)×109/L、(7.2±2.3)mg/L、(16±3)ng/L、(17±4) ng/L变化为术后第6天的(10.2±0.9)×109/L、(25.5±6.3)mg/L、(24±4)ng/L、(22±5)ng/L,对照组上述指标分别由术前1天的(7.4±0.8)×109/L、(6.9±2.4)mg/L、(17±4)ng/L、(16±4) ng/L变化为术后第6天的(13.0±1.3)×109/L、(41.6±18.9)mg/L、(45±8)ng/L、(43±7)ng/L。两组患者上述指标变化趋势比较,差异均有统计学意义(F=63.05,51.65,127.82,104.91,P<0.05)。(3)围术期免疫学指标检测情况:试验组患者免疫球蛋白A、免疫球蛋白G、免疫球蛋白M、CD4+、CD8+、CD4+/CD8+分别由术前1天的(1.5±0.4)g/L、(11.1±1.7)g/L、(0.77±0.28)g/L、42%±6%、23%±4%、1.82±0.42变化为术后第6天的(2.8±0.5)g/L、(14.0±1.2)g/L、(1.61±0.31)g/L、46%±5%、24%±3%、2.11±0.24,对照组上述指标分别由术前1天的(1.4±0.4)g/L、(10.7±1.8)g/L、(0.69±0.23)g/L、40%±5%、24%±3%、1.75±0.34变化为术后第6天的(2.3±0.6)g/L、(11.9±1.4)g/L、(1.19±0.33)g/L、39%±4%、23%±3%、1.81±0.35。两组患者免疫球蛋白A、免疫球蛋白G、免疫球蛋白M、CD4+、CD4+/CD8+变化趋势比较,差异均有统计学意义(F=18.39,15.20,38.42,9.55,5.50,P<0.05);两组患者CD8+变化趋势比较,差异无统计学意义(F=0.89,P>0.05)。(4)术后并发症情况:试验组患者术后并发症发生率为16.7%(5/30),其中腹腔感染1例、切口感染1例、肺部感染3例;患者经对症支持治疗后痊愈。对照组患者术后并发症发生率为30.0%(9/30),其中腹腔感染2例、切口感染2例、肺部感染5例;患者经对症支持治疗后痊愈。两组患者并发症发生率比较,差异无统计学意义(x=1.491,P>0.05)。
结论:ω-3鱼油脂肪乳能有效减轻胃癌患者胃癌根治术后炎症反应,提高患者自身免疫力,不增加术后并发症发生率。

【Abstract】

Objective:To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer.
MethodsZ:The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA.
Results: (1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×109/L to (10.2±0.9)×109/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×109/L to (13.0±1.3)×109/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P<0.05). (3) Immune indicators in the perioperative period: the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4+,CD8+, and ratio of CD++/CD++ from preoperative day 1 to preoperative day 6 were respectively from (1.5±0.4)g/L to (2.8±0.5)g/L, from (11.1±1.7)g/L to (14.0±1.2)g/L, from (0.77±0.28)g/L to (1.61±0.31)g/L, from 42%±6% to 46%±5%, from 23%±4% to 24%±3%, from 1.82±0.42 to 2.11±0.24 in the experimental group and from (1.4±0.4)g/L to (2.3±0.6)g/L, from (10.7±1.8)g/L to (11.9±1.4)g/L, from (0.69±0.23)g/L to (1.19±0.33)g/L, from 40%±5% to 39%±4%, from 24%±3% to 23%±3%, from 1.75±0.34 to 1.81±0.35 in the control group, respectively, showing significant differences in the changing trends of the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4+, and ratio of CD4+/CD8+ between the two groups (F=18.39, 15.20, 38.42, 9.55, 5.50, P<0.05), showing no significant difference in the changing trend of the levels of CD8+ between the two groups (F=0.89, P>0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured after symptomatic treatment. Nine patients had postoperative complications, with a incidence rate of 30.0%(9/30), including 2 of abdominal infection, 2 of incisional infection, and 5 of pulmonary infection, and all the 9 patients were cured after symptomatic treatment. There was no significant difference in the incidence of postoperative complications between the two groups (χ2=1.491, P>0.05).
Conclusion:For patients who receive gastric cancer surgery, ω-3 fish oil fat emulsion can reduce the inflammatory response, improve their immune function and not increase postoperative complications.

DOI:10.3760/cma.j.issn.1673-9752.2019.10.012
基金项目:江苏省自然科学基金(BK20170206) ,无锡市科教强卫工程(QNRC026)
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