ω-3鱼油脂肪乳对膀胱全切术后患者炎症和凝血及免疫功能的影响

摘要

Objective To study the effects of ω-3 fish oil fat emulsion on inflammation,coagulation and immunologic function in patients after total resection of bladder.Methods Ninty-six patients after radical bladder resection and intestinal urinary diversion were randomly divided into fish oil (FO) group (48 cases) and medium/long chain fat emulsion (MCT) group (48 cases).Postoperative parenteral nutrition support was intravenously given with 30％ common medium/long chain fat emulsion [1.0 g/(kg · d)] in MCT group,30％common medium/long chain fat emulsion [1.0 g/(kg · d)] + ω-3 fish oil fat emulsion [0.2 g/(kg · d)] in FO group,the injection speed was not more than 30 drips/min and lasted for 7 days.The levels of C-reactive protein (CRP),interlukin-6 (IL-6),tumor necrosis factor alpha (TNF-α),prothrombin time,platelet count,CD4 count and CD4/CD8 ratio before and after operation were detected and compared between groups.Results The related indexes were not significantly different between groups before operation.Three days after operation,the levels of CRP,IL-6,TNF-α were significantly lower,the CD4/CD8 ratio was significantly higher than in FO group than those in MCT group [(12.94 ±2.20) mg/L vs (27.04±3.76) mg/L,(37.2±2.1) ng/Lvs (55.4±1.7) ng/L,(59±6) ng/Lvs (85±5) ng/L,(2.35±0.30) vs (1.55±0.22)](P ＜ 0.05).Seven days after operation,the CD4 count and CD4/CD8 ratio in FO group were significantly higher than those inMCTgroup [(1 304 ±92)/μlvs (892±76) /μl,(2.27±0.21) vs (1.64±0.27)] (P＜0.05).The albumine,platelet count and blood coagulation function were not significantly different between groups 3 and 7 days after operation (P ＞ 0.05).Conclusion ω-3 fish oil fat emulsion can reduce the inflammatory state and increase the immunologic function in patients after total resection of bladder,without changing the coagulation function.%目的 探讨ω-3鱼油脂肪乳对膀胱全切术后患者炎症和凝血及免疫功能的影响.方法 选择2013年9月至2015年6月在郑州大学第一附属医院行根治性膀胱切除加术后原位膀胱或回肠通道术患者96例,完全随机分为鱼油组(48例)及普通中长链脂肪乳组(48例).术后肠外营养支持鱼油组给予普通中长链脂肪乳1 g/(kg·d)加ω-3鱼油脂肪乳0.2 g/(kg·d),普通中长链脂肪乳组给予普通中长链脂肪乳1.2 g/(kg·d)(滴速不高于30滴/min),2组均连续应用7d.观察并比较2组患者术前、术后第3天、第7天C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、凝血酶原时间、血小板计数、白蛋白、CD4计数和CD4/CD8比值.结果 2组患者术前各项指标比较,差异均无统计学意义(P＞0.05).术后第3天,鱼油组CRP、IL-6、TNF-α水平明显低于普通中长链脂肪乳组[(12.94 ±2.20) mg/L比(27.04 ±3.76) mg/L、(37.2±2.1)ng/L比(55.4±1.7)ng/L、(59±6) ng/L比(85±5)ng/L],CD4/CD8比值明显高于普通中长链脂肪乳组[(2.35±0.30)比(1.55±0.22)],差异均有统计学意义(均P＜0.05).术后第7天,鱼油组CD4及CD4/CD8比值明显高于普通中长链脂肪乳组[(1 304±92)个/μl比(892±76)个/μl、(2.27±0.21)比(1.64±0.27)],差异均有统计学意义(均P＜0.05).2组患者术后白蛋白、血小板计数及凝血酶原时间比较,差异均无统计学意义(均P＞0.05).结论 ω-3鱼油脂肪乳能降低膀胱全切肠道尿流改道患者的炎症状态,增加免疫功能,对凝血功能无明显影响.