ω-3多不饱和脂肪酸对重症脓毒症心肌损伤的保护作用  

Protective effects of ω-3 polyunsaturated fatty acids on severe sepsis patients with myocardial injury

作　　者：幸泽茂[1] 熊丽红[1] 张宪华[1] 郑晓英[1] 

机构地区：[1]深圳市第二人民医院急诊ICU,518035

出　　处：《中国医师进修杂志》2013年第22期9-11,共3页Chinese Journal of Postgraduates of Medicine

基　　金：深圳市科技局计划非资助项目（201003044）

摘　　要：目的探讨ω-3多不饱和脂肪酸对重症脓毒症患者心肌损伤的保护作用。方法31例重症脓毒症患者按随机数字表法分为治疗组（17例）和对照组（14例）。两组均应用等氮、等热量肠内及肠外混合营养治疗5d。治疗组采用10％鱼油脂肪乳注射液＋中长链脂肪乳，对照组采用中长链脂肪乳。观察比较两组治疗前1d及治疗5d后血清丙二醛（MDA）、超氧化物歧化酶（SOD）、心肌肌钙蛋白Ⅰ（cTnⅠ）、N-末端B型尿钠肽前体（NT-proBNP）水平和急性生理学与慢性健康状况Ⅱ（APAcHEⅡ）评分。结果治疗前1d两组各项指标比较差异无统计学意义（P〉0．05）。两组治疗5d后MDA、cTnⅠ、NT．proBNP、APACHEⅡ评分均较治疗前1d降低，SOD升高，差异均有统计学意义（P〈0．05）；且治疗组治疗5d后MDA、SOD、cTnⅠ、NT-proBNP较对照组改善更明显[（7．5±2．06）mmol/L比（9．24±1．79）mmol／L、（89．22±16．21）mU/L比（76．60±15．13）mU／L、（0．65±0．34）μg/L比（1．03±0．62）μgol/L、（1267．13±279．26）ng/L比（1532．47±375．73）ng／L]，差异有统计学意义（P〈0．05）。两组治疗5d后APACHEⅡ评分比较差异无统计学意义（P〉0．05）。结论ω-3多不饱和脂肪酸能够减轻重症脓毒症患者氧化应激反应，减轻心肌损伤，降低cTnⅠ及NT-proBNP水平，改善心功能。Objective To investigate the protective effects of ω-3 polyunsaturated fatty acids on severe sepsis patients with myocardial injury. Methods Thirty-one patients with severe sepsis were divided into treatment group （ 17 cases） and control group （ 14 cases） by random digits table. All patients received partial enteral nutrition and partial parenteral nutrition with equivalent nitrogen and calorie values for 5 days. The control group was given routine therapy and the treatment group was given routine therapy andω-3 polyunsaturated fatty acids emulsion. The serum malondialdehyde （MDA）, superoxide dismutase （SOD）, cardiac troponin Ⅰ（cTnⅠ）, N-terminal pro-B urine sodium peptide （NT-proBNP） levels and acute physiology and chronic health evaluation （APACHE） Ⅱ score was compared between two groups before and aftertreatment. Results There was no difference in indicators before treatment between two groups （P 〉 0.05）. The MDA, eTnI, NT-proBNP and APACHE Ⅱ score in two groups after treatment 5 days was lower than that before treatment 1 day, and the SOD was higher than that before treatment （P 〈 0.05 ）. The MDA, SOD, cTnⅠ and NT-proBNP after treatment 5 days in treatment group was better than that in control group [ （7.50± 2.06） mmol/L vs. （9.24 ± 1.79） mmol/L, （89.22 ± 16.21） mU/L vs. （76.60 ± 15.13） mU/L, （0.65 ±0.34）μ/L vs. （ 1.03 ±0.62 ） μ g/L, （ 1267.13 ± 279.26） ng/L vs. （ 1532.47 ± 375.73 ） ng/L ], and there was significant difference between two groups （P 〈 0.05 ）. The APACHE Ⅱ score was no significant difference between two groups after treatment 5 days . Conclusion ω-3 polyunsaturated fatty acids can reduce the oxidative stress and myocardial injury, decrease cTnⅠ and NT-proBNP levels and improve heart function in the patients with severe sepsis.

关 键 词：脓毒症 脂肪酸类 不饱和 心肌 氧化性应激 

分 类 号：R459.7[医药卫生—急诊医学]