ω-3多不饱和脂肪酸对老年胃癌患者术后谵妄的预防作用  

Prophylactic effect of ω-3 polyunsaturated fatty acids on delirium in elderly patients after gastric cancer surgery

作　　者：梁涛[1] 伍晓汀[1] LIANG Tao;WU Xiaoting(Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院胃肠外科,成都610041

出　　处：《中国普外基础与临床杂志》2019年第2期174-179,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨ω-3多不饱和脂肪酸对胃癌术后老年患者谵妄发生的影响。方法前瞻性收集2015年6月至2018年6月期间于四川大学华西医院胃肠外科行胃癌根治术的老年患者210例,均分为试验组和对照组。2组患者由同一组手术医师及麻醉师完成手术。试验组患者从术后第1天开始在常规治疗措施的基础上,每天额外静脉输注10%的鱼油脂肪乳剂100 mL;对照组患者术后采取常规治疗措施。比较2组患者术后谵妄的情况,以及炎症反应、并发症、住院时间及30 d再入院的发生情况。结果共计205例患者完成研究,其中试验组103例,对照组102例。①对照组共发生谵妄47例,试验组共发生22例,2组患者的谵妄发生率比较差异具有统计学意义(P<0.001)。术后1～3 d对照组和试验组各发生谵妄32例和19例,术后4～7天各发生19例和6例,同时点2组的谵妄发生率比较差异均有统计学意义(P<0.05)。②术后3 d和7 d,试验组患者的WBC计数、CRP、IL-6、TNF-α、PCT及血糖均较对照组低(P<0.05)。③术后试验组共有46例患者发生术后发热,而对照组发生71例,对照组的发热发生率较高(P<0.01)。④对照组术后发生切口液化2例,试验组发生轻度乳糜漏1例,2组的切口液化发生率和乳糜漏发生率比较差异均无统计学意义(P>0.05)。⑤试验组患者的术后住院时间为(8±1)d,较对照组[(9±2)d]缩短(P<0.01);此外,试验组无患者30 d内再次入院,对照组有4例,对照组的30 d再入院率较高(P=0.04)。结论老年胃癌术后使用ω-3多不饱和脂肪酸可以通过控制患者的炎症及应激反应,降低患者术后谵妄的发生,改善短期预后。Objective To investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.Methods A prospective study was conducted.Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research.All patients were operated by the same group of surgeons and anesthesiologists.Patients in the experimental group received intravenous infusion of 10%fish fat emulsion(Ewing)100 mL daily from the first day after operation extra to routine treatment;patients in the control group received routine treatment after operation.The postoperative delirium,inflammation,complications,hospital stay,and re-admission on 30 days were compared between the two groups.Results A total of 205 patients were under research.The results were as follows.①There were 47 delirium patients in the control group and 22 delirium patients in the experimental group.The difference between the two groups was statistically significant(P<0.001).There were 32 cases and19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation;there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation,respectively.The difference was considered statistically significant(P<0.05).②Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3rd and 7th day after operation,including count of WBC,C-reactive protein,interleukin-6,tumor necrosis factor-α,and platelet crit,and the difference were statistically significant(P<0.05).③Postoperative fever occurred in 46 patients in the experimental group,while 71patients in the control group.The difference was statistically significant(P<0.01).④There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leak

关 键 词：Ω-3多不饱和脂肪酸 术后谵妄 胃癌 老年患者 前瞻性研究 

分 类 号：R735.2[医药卫生—肿瘤]