鱼油脂肪乳在肝硬化、门静脉高压症贲门周围血管离断联合脾切除术营养支持应用的随机对照临床研究  

Fish oil fat emulsion nutritional support in the treatment of liver cirrhosis and portal hypertension in patients with pericardial devascularization with splenectomy: A randomized clinical trial

作　　者：玛丽亚 何跃明[1] 刘权焰[1] 张中林[1] 潘定宇[1] 袁玉峰[1] 刘志苏[1] Maria.F.Toledo.P.;He Yueming;Liu Quanyan;Zhang Zhonglin;Pan Dingyu;Yuan Yufeng;Liu Zhisu(Department of Hepatobiliary & Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肝胆胰腺外科,武汉430071

出　　处：《中华临床营养杂志》2019年第1期11-17,共7页Chinese Journal of Clinical Nutrition

摘　　要：目的 探讨鱼油脂肪乳在肝硬化、门静脉高压症围术期营养支持应用的效果.方法 采用随机对照临床研究201 1年9月~2017年9月接受开腹贲门周围血管离断联合脾切除术的肝硬化、门静脉高压症患者,行等氮(低)、等热卡(低)全胃肠外营养支持(TPN),从术后第一天开始,连续5d.根据脂肪乳剂的不同分实验组(43例)为鱼油脂肪乳(10%尤文)+中长链结构脂肪乳(20% STG)和对照组(42例)为中长链结构脂肪乳(20% STG).比较手术前后肝功能总胆红素、丙氨酸氨基转移酶,营养指标白蛋白、前白蛋白,炎性介质TNF-α、IL-6和IL-10的变化,观察术后的临床结果.结果 实验组和对照组的肝功能和营养指标差异没有统计学意义(P>0.05).术后1天炎症介质[实验组和对照组TNF-α、IL-6、IL-10分别是(225.54±54.78)、(74.94±6.36)、(77.53±11.4) ng/L和(229.26±62.15)、(77.23±7.83)、(73.89±7.97) ng/L]均明显高于术前[实验组和对照组TNF-α、IL-6、IL-10分别是(61.49±16.47)、(39.84±2.77)、(46.05±6.13) ng/L和(63.48±13.76)、(40.64±3.34)、(44.88±5.72) ng/L] (P<0.01);随术后时间的延长两组的促炎因子TNF-α、IL-6均明显下降,实验组[d4-d1和d7-d1分别为(-56.88±31.63)、(-13.52±5.20)ng/L和(-150.67±42.58)、(-27.04±8.97)ng/L]下降幅度明显高于对照组[d4-d1和d7-d1分别为(-35.96±20.02)、(-6.38±2.84)和(-132.79±53.35)、(-20.85±6.38)ng/L] (P<0.05);实验组抗炎因子IL-10 [d4-d1和d7-d1分别为(14.22±13.08)和(17.78±5.58) ng/L]的升高幅度明显高于对照组[d4-d1和d7-d1分别为(5.64±3.58)和(-37.96±11.43)ng/L] (P<0.05).实验组术后的Ⅲ级并发症和总并发症发生率(分别是4.7%和23.3%)及住院时间[(10.12±1.48)d]均明显低于对照组[(分别为21.4%和45.2%),(12.33±2.04) ng/L] (P<0.05).结论 在肝硬化、门静脉高压症采用鱼油脂肪乳围术期营养支持,可以通过其双向调节炎症介质作用,减轻全身炎症反应,减少术后并发症,促进快速康复.Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension. Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy. Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days. Patients were divided into experimental group and control group according to the type of fat emulsion used. 43 patients in experimental group were applied for fish oil fat emulsion injection (10% Omegaven)+ medium long chain structure fat emulsion (20% STG) and 42 patients in control group were applied for medium long chain structure fat emulsion(20%STG). Liver function (total bilirubin and alanine aminotransferase), nutrition index (serum albumin and prealbumin), inflammatory mediators (TNF-ɑ, IL-6 and IL-10) were measured before and after the operation, and the clinical outcomes were observed. Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P>0.05). The inflammatory mediators like TNF-ɑ, IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78)vs.(61.49±16.47),(74.94±6.36)vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13)ng/L;control group:(229.26±62.15)vs.(63.48±13.76),(77.23±7.83) vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72)ng/L;P< 0.01]. With the progress of time, the proinflammatory factors like TNF-ɑ and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group[d4-d1:(-56.88±31.63)vs.(-35.96±20.02),(-13.52±5.20)vs.(-6.38±2.84)ng/L;d7-d1:(-150.67±42.58)vs.(-132.79±53.35),(-27.04±8.97)vs.(-20.85±6.38)ng/L;P< 0.05]. The range of increase in anti-inflammatory me

关 键 词：鱼油脂肪乳 炎症介质 肝硬化 门静脉高压症 围术期营养支持 

分 类 号：R473.6[医药卫生—护理学]