中国普外基础与临床杂志

中国普外基础与临床杂志

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

查看全文

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, andre-admission on 30 days were compared between the two groups. Results A total of 205 patients were under research. The results were as follows. ① There 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 and 19 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). ② Inflammation 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). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group [(8±1) dvs. (9±2) d]. The difference was considered statistically significant (P<0.01). Conclusion ω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.

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

Key words: ω-3 polyunsaturated fatty acids; postoperative delirium; gastric cancer; elderly patient; perspective study

引用本文: 梁涛, 伍晓汀. 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. 中国普外基础与临床杂志, 2019, 26(2): 174-179. doi: 10.7507/1007-9424.201808042 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920): 911-922.
2. Brouquet A, Cudennec T, Benoist S, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg, 2010, 251(4): 759-765.
3. Olin K, Eriksdotter-Jönhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg, 2005, 92(12): 1559-1564.
4. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
5. Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry, 2013, 21(12): 1190-1222.
6. 王瑾, 于健春, 康维明, 等. 鱼油脂肪乳剂对炎症的影响及其临床应用. 中国实用外科杂志, 2011, 31(4): 354-357.
7. 赵明利, 于健春, 康维明. 脂肪乳剂的研究进展. 中国临床营养杂志, 2008, 16(3): 184-191.
8. 黎介寿. 临床营养支持的发展趋势. 肠外与肠内营养, 2010, 17(1): 1-4.
9. 王新颖, 黎介寿. ω-3 多不饱和脂肪酸影响炎症和免疫功能的基础研究. 肠外与肠内营养, 2007, 14(1): 54-58.
10. Heude B, Ducimetière P, Berr C, et al. Cognitive decline and fatty acid composition of erythrocyte membranes—the EVA Study. Am J Clin Nutr, 2003, 77(4): 803-808.
11. Tan ZS, Harris WS, Beiser AS, et al. Red blood cell ω-3 fatty acid levels and markers of accelerated brain aging. Neurology, 2012, 78(9): 658-664.
12. Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract, 2009, 24(4): 487-499.
13. Han YY, Lai SL, Ko WJ, et al. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract, 2012, 27(1): 91-98.
14. Ortiz Leyba C, Montejo González JC, Vaquerizo Alonso C, et al. Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente sépticoGuidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): patient with sepsis. Med Intensiva, 2011, 35(Suppl 1): 72-76.
15. Cotogni P, Muzio G, Trombetta A, et al. Impact of the omega-3 to omega-6 polyunsaturated fatty acid ratio on cytokine release in human alveolar cells. JPEN J Parenter Enteral Nutr, 2011, 35(1): 114-121.
16. Hagi A, Nakayama M, Shinzaki W, et al. Effects of the omega-6: omega-3 fatty acid ratio of fat emulsions on the fatty acid composition in cell membranes and the anti-inflammatory action. JPEN J Parenter Enteral Nutr, 2010, 34(3): 263-270.
17. Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition, 2012, 28(6): 623-629.
18. Hao W, Wong OY, Liu X, et al. ω-3 fatty acids suppress inflammatory cytokine production by macrophages and hepatocytes. J Pediatr Surg, 2010, 45(12): 2412-2418.
19. Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr, 2005, 24(1): 55-65.
20. Heller AR, Rössel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer, 2004, 111(4): 611-616.
21. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
22. Gianotti L, Braga M, Nespoli L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology, 2002, 122(7): 1763-1770.
23. Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res, 2003, 36(4): 433-446.
24. Rao GH, Radha E, White JG. Effect of docosahexaenoic acid (DHA) on arachidonic acid metabolism and platelet function. Biochem Biophys Res Commun, 1983, 117(2): 549-555.
25. Pottala JV, Yaffe K, Robinson JG, et al. Higher RBC EPA+DHA corresponds with larger total brain and hippocampal volumes: WHIMS-MRI study. Neurology, 2014, 82(5): 435-442.
26. Dangour AD, Allen E, Elbourne D, et al. Effect of 2-y n-3 long-chain polyunsaturated fatty acid supplementation on cognitive function in older people: a randomized, double-blind, controlled trial. Am J Clin Nutr, 2010, 91(6): 1725-1732.
27. Van de Rest O, Geleijnse JM, Kok FJ, et al. Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology, 2008, 71(6): 430-438.
28. Yurko-Mauro K, McCarthy D, Rom D, et al. Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline. Alzheimers Dement, 2010, 6(6): 456-464.
29. Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
30. Cooper RE, Tye C, Kuntsi J, et al. Omega-3 polyunsaturated fatty acid supplementation and cognition: a systematic review and meta-analysis. J Psychopharmacol, 2015, 29(7): 753-763.