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Multiple organ dysfunction syndrome (MODS) patients or intestinal failure due to infection and other factors,intestinal dysfunction can not complete the absorption of nutrients and electrolytes.Progressive malnutrition in severe patients usually develops rapidly.Early parenteral nutrition can significantly improve the prognosis of MODS patients.PN is now widely used in all kinds of severe patients,but parenteral nutrition-associated liver disease (PNALD) caused by parenteral nutrition is prevalent in such patients.The emergence of PNALD increases the difficulty of curing patients' diseases.Many studies have found thatω-3fish oil fat emulsion in nutrient solution is an effective way to prevent and improve PNALD.
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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 thetype 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-α,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-u,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-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-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 media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.
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Objective@#To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer.@*Methods@#The retrospective cohort study was conducted. The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected. There were 37 males and 23 females, aged from 28 to 78 years, with an average age of 64 years. Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group, respectively. Observation indicators: (1) nutritional indicators in the perioperative period; (2) inflammatory indicators in the perioperative period; (3) immune indicators in the perioperative period; (4) postoperative complications. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated using the independent-sample t test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Repeated measurement data were analyzed by the repeated measures ANOVA.@*Results@#(1) Nutritional indicators in the perioperative period: the levels of total protein, albumin, prealbumin, and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2±3.1)g/L, from (35.3±3.1)g/L to (37.0±1.8)g/L, from (186±24)mg/L to (172±17)mg/L, from (3.0±0.7)g/L to (2.4±0.4)g/L in the experimental group and from (60.6±2.4)g/L to (55.7±4.2)g/L, from (35.0±3.8)g/L to (36.0±3.8)g/L, from (184±18)mg/L to (173±25)mg/L, from (3.1±0.6)g/L to (2.2±0.8)g/L in the control group, with no significant difference in the changing trends between the two groups (F=0.79, 2.14, 0.03, 0.36, P>0.05). (2) Inflammatory indicators in the perioperative period: the levels of white blood cells, C-reactive protein, interleukin 6, and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1)×109/L to (10.2±0.9)×109/L, from (7.2±2.3)mg/L to (25.5±6.3)mg/L, from (16±3)ng/L to (24±4)ng/L, from (17±4)ng/L to (22±5)ng/L in the experimental group and from (7.4±0.8)×109/L to (13.0±1.3)×109/L, from (6.9±2.4)mg/L to (41.6±18.9)mg/L, from (17±4)ng/L to (45±8)ng/L, from (16±4)ng/L to (43±7)ng/L in the control group, respectively, with significant differences in the changing trends between the two groups (F=63.05, 51.65, 127.82, 104.91, P<0.05). (3) Immune indicators in the perioperative period: the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4+, CD8+, and ratio of CD4+ /CD8+ from preoperative day 1 to preoperative day 6 were respectively from (1.5±0.4)g/L to (2.8±0.5)g/L, from (11.1±1.7)g/L to (14.0±1.2)g/L, from (0.77±0.28)g/L to (1.61±0.31)g/L, from 42%±6% to 46%±5%, from 23%±4% to 24%±3%, from 1.82±0.42 to 2.11±0.24 in the experimental group and from (1.4±0.4)g/L to (2.3±0.6)g/L, from (10.7±1.8)g/L to (11.9±1.4)g/L, from (0.69±0.23)g/L to (1.19±0.33)g/L, from 40%±5% to 39%±4%, from 24%±3% to 23%±3%, from 1.75±0.34 to 1.81±0.35 in the control group, respectively, showing significant differences in the changing trends of the levels of immunoglobulin A, immunoglobulin G, immunoglobulin M, CD4+, and ratio of CD4+ /CD8+ between the two groups (F=18.39, 15.20, 38.42, 9.55, 5.50, P<0.05), showing no significant difference in the changing trend of the levels of CD8+ between the two groups (F=0.89, P>0.05). (4) Postoperative complications: 5 patients had postoperative complications, with a incidence rate of 16.7%(5/30), including 1 of abdominal infection, 1 of incisional infection, and 3 of pulmonary infection, and all the 5 patients were cured after symptomatic treatment. Nine patients had postoperative complications, with a incidence rate of 30.0%(9/30), including 2 of abdominal infection, 2 of incisional infection, and 5 of pulmonary infection, and all the 9 patients were cured after symptomatic treatment. There was no significant difference in the incidence of postoperative complications between the two groups (χ2=1.491, P>0.05).@*Conclusion@#For patients who receive gastric cancer surgery, ω-3 fish oil fat emulsion can reduce the inflammatory response, improve their immune function and not increase postoperative complications.
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Objective To investigate the application value of ω-3 fish oil fat emulsion in the parenteral nutritional support treatment following radical gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinical data of 60 patients who underwent radical gastrectomy for gastric cancer in Nanjing Medical University Affiliated Wuxi Second Hospital between January 2018 and December 2018 were collected.There were 37 males and 23 females,aged from 28 to 78 years,with an average age of 64 years.Thirty patients who received parenteral nutrition containing 100 mL of ω-3 fish oil fat emulsion after radical gastrectomy and 30 patients who received parenteral nutrition containing routine fat emulsion after radical gastrectomy were allocated into experimental group and control group,respectively.Observation indicators:(1) nutritional indicators in the perioperative period;(2) inflammatory indicators in the perioperative period;(3) immune indicators in the perioperative period;(4) postoperative complications.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated using the independent-sample t test.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chi-square test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results (1) Nutritional indicators in the perioperative period:the levels of total protein,albumin,prealbumin,and transferrin from preoperative day 1 to preoperative day 6 were respectively changed from (60.2±3.0)g/L to (57.2± 3.1)g/L,from (35.3±3.1)g/L to (37.0±1.8)g/L,from (186±24)mg/L to (172±17)mg/L,from (3.0± 0.7) g/L to (2.4 ± 0.4) g/L in the experimental group and from (60.6± 2.4) g/L to (55.7 ± 4.2) g/L,from (35.0±3.8)g/L to (36.0±3.8) g/L,from (184±18)mg/L to (173±25)mg/L,from (3.1±0.6)g/L to (2.2± 0.8)g/L in the control group,with no significant difference in the changing trends between the two groups (F=0.79,2.14,0.03,0.36,P＞0.05).(2) Inflammatory indicators in the perioperative period:the levels of white blood cells,C-reactive protein,interleukin 6,and tumor necrosis factor-α from preoperative day 1 to preoperative day 6 were respectively from (7.2±1.1) ×109/L to (10.2±0.9) ×109/L,from (7.2±2.3) mg/L to (25.5±6.3) mg/L,from (16± 3) ng/L to (24± 4) ng/L,from (17± 4) ng/L to (22± 5) ng/L in the experimental group and from (7.4±0.8) × 109/L to (13.0±1.3) × 109/L,from (6.9±2.4) mg/L to (41.6± 18.9) mg/L,from (17±4) ng/L to (45±8)ng/L,from (16±4)ng/L to (43±7)ng/L in the control group,respectively,with significant differences in the changing trends between the two groups (F=63.05,51.65,127.82,104.91,P＜0.05).(3) Immune indicators in the perioperative period:the levels of immunoglobulin A,immunoglobulin G,immunoglobulin M,CD4+,CD8+,and ratio of CD4+/CD8+ from preoperative day 1 to preoperative day 6 were respectively from (1.5±0.4)g/L to (2.8±0.5)g/L,from (11.1±1.7)g/L to (14.0±1.2)g/L,from (0.77± 0.28)g/L to (1.61±0.31)g/L,from 42％±6％ to 46％±5％,from 23％±4％ to 24％±3％,from 1.82±0.42 to 2.11±0.24 in the experimental group and from (1.4±0.4) g/L to (2.3±0.6) g/L,from (10.7± 1.8) g/L to (11.9± 1.4)g/L,from (0.69±0.23)g/L to (1.19±0.33)g/L,from 40％±5％ to 39％±4％,from 24％±3％ to 23％±3％,from 1.75±0.34 to 1.81±0.35 in the control group,respectively,showing significant differences in the changing trends of the levels of immunoglobulin A,immunoglobulin G,immunoglobulin M,CD4+,and ratio of CD4+/CD8+ between the two groups (F=18.39,15.20,38.42,9.55,5.50,P＜0.05),showing no significant difference in the changing trend of the levels of CD8+ between the two groups (F =0.89,P ＞ 0.05).(4)Postoperative complications:5 patients had postoperative complications,with a incidence rate of 16.7％ (5/30),including 1 of abdominal infection,1 of incisional infection,and 3 of pulmonary infection,and all the 5 patients were cured after symptomatic treatment.Nine patients had postoperative complications,with a incidence rate of 30.0％(9/30),including 2 of abdominal infection,2 of incisional infection,and 5 of pulmonary infection,and all the 9 patients were cured after symptomatic treatment.There was no significant difference in the incidence of postoperative complications between the two groups (x2 =1.491,P＞0.05).Conclusion For patients who receive gastric cancer surgery,ω-3 fish oil fat emulsion can reduce the inflammatory response,improve their immune function and not increase postoperative complications.
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The incidence of severe acute pancreatitis (SAP) is increasing year by year,and the mortality is high,which poses a great threat to the life of patients.In recent years,the immune nutrition therapy has become the focus in the treatment of SAP,among which,fish oil lipid emulsion as a novel type of fat emulsion,has the multi-effects of anti-inflammatory,anti-oxidative,immunomodulatory,promoting signal transduction and protecting organ function apart from providing nutrition and regulating metabolism.It can prevent the deterioration of the whole body from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS and ultimately improve the prognosis of patients.
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Inflammation,immune suppression and oxidative stress is the main pathogenesis of sepsis.In recent years,more study have found ω-3 polyunsaturated fatty acid(ω-3PUFA) can inhibit inflammation by some mechanisms namely,reducing metabolites from arachidonic acid(AA) by competing with it through a variety of ways,alteration of membrane lipid rafts,inhibition of nuclear receptor activation(specifically nuclear factor NF-κB)to modulate production of inflammatory mediators,and metabolism into novel pro-resolving and antiinflammatory mediators (resolvins and protectins).In addition,ω-3PUFA can reduce oxidative stress by improvement the antioxidant defense system,etc.Many clinical studies have demonstrated that ω-3PUF is effective in the for sepsis patients.The paper reviews the specific mechanism of ω-3PUFA treatment for sepsis.
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Objective to investigate the protective effect of omega-3 fish oil fat emulsion on cyclophosphamide-induced gastric mucosal injury in mice. Methods Forty-five kunming mice were randomly divided into three groups as control,model,and omega-3 fish oil fat emulsion group(with 15 mice in each group). Mice of the two experiment groups were administrated with cyclophosphamide i.p. for 2 days to establish the damage model. then mice in omega-3 fish oil fat emulsion group received omega-3 fish oil fat emulsion at a dose of 15 mL/kg daily for 14 days. Meanwhile,the ani-mals in control group and model group were intravenously administered with the same volume of saline. the weight and food intake of the mice in each group were assessed daily. Five mice in each group were respectively sacrificed at day 1,day 7,day 14 after intravenous injection. Morphology of gastric mucosa was observed by HE staining and the activities of SOD and MAO in gastric mucosa were measured respectively by xanthine oxida-tion and ultraviolet spectrophotometry methods. Results Compared with the model group,the general status,nutritional status and the injury in stomach mucosa in omega-3 fish oil fat emulsion group were significantly improved. After 14 day′s treatment,the activities of SOD and MAO in gas-tric mucosa of mice in omega-3 fish oil fat emulsion group were significantly increased(P < 0.05)compared with model group. Conclusion omega-3 fish oil fat emulsion has a significant protective effect on the cyclophosphamide induced injury in gastric mucosa of mice,which may be related to the upregulation of MAO and SOD.
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Objective: To investigate the effects of ω-3 fish oil fat emulsion on nutritional status and humoral immunity in postoperative patients suffering from gastrointestinal malignancy. Methods: Thirty patients of gastrointestinal malignancy were randomly divided into study group (n = 15) and control group (n = 15). All the patients were assigned to receive total parenteral nutrition with the equal nitrogen and calory,and those in study group received fish oil fat emulsion additionally. Liver and renal function, blood lipid, haemoglobin, albumin, transferrin, total lymphocyte count (TLC) , B lymphocyte subsets (B1, B2), immunoglobin(IgG, IgM, IgA) and complement(C3, C4) were determined preoperatively and 1, 6d postoperatively. Results: There were no significant differences in liver and renal function and blood lipid on postoperative day 6 versus preoperation in all the two groups. TLC, IgG, IgM, C3 on postoperative day 6 were siginificantly higher in the study group(P < 0. 05). Haemoglobin, albumin, transferrin and B lymphocyte subsets were not significantly different between the two groups. Conclusion: Fish oil fat emulsion treatment was safe and tolerated, and could improve the humoral immunity in patients.
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Objective To explore the effects of fat emulsion made of fish oil for total parenteml nutrition on patients with systemic inflammatory response syndrome(SIRS).Methos Forty patients with SIRS in the intensive care unit(ICU),Liaocheng People's Hospital,from January to June 2007 were randomly divided into conventional total parenteral nutrition(TPN)group(group A,n=20)and fish oil emulsion+TIN group(group B,n=20).Patients of both groups received equal amount of nitrogen and calories.The energy give.Was 20 kcal/(kg·d),and nitrogen 0.2 g/(kg·d)for 7 days and the fish oil emulsion given was 1-2 ml/(kg·d)(Commoditieds:Omegaven,No.UK 1580,Wuxi,China SINO-SWEO Pharmaceutical CORP.Ltd.).The levels of serurn TNF-α,IL-1 and IL-6 were checked before TPN and 1 d,3 d and 7 d after TPN.The davs of ICU stay,the incidence of MODS and the mortality within 28 aays of two groups were also recorded.Data were analyzed wotj inde pent-saraples t test and paired-sarnples t test using the SPSS 10.34 software.Results There wsa no significant difference in APACHF-Ⅱ score between two groups of patients.Compared with group A,the levels of serum TNF-α,IL-1 and IL-6 in group B decreased markedly at different intervals(P<0.05,P<0.01).The duration of ICU slay shortened obviously in group B than that in group A[(11.5±2.4)days vs.(15.8±2.3)days,P<0.05].Conclusions The fat emulsion made of fish oil has protective effects on patients with SIRS by the mechanism of decrease in the levek of Serum TNF-α,IL-1 and IL-6,and thereby reduees the incidence of MODS,shortens the duration of ICU stay,increasing the survival rote of seriously ill patients.
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Objective To explore the effect of?-3 fish oil fat emulsion on the release of pro-inflam- matory cytokines in patients with systemic inflammatory response syndrome(SIRS).Methods Forty patients with SIRS in the intensive care unit(ICU)from June 2006 to June 2007 were randomly divided into routine total parenteral nutrition(TPN)group(group A,20 cases)and?-3 fish oil fat emulsion+TPN treatment group(group B,20 cases).All the patients received treatment of parenteral nutrition with equal nitrogen content and calories.The caloric value given was 83.68 kJ?kg~(-1)?d~(-1),with 0.2 g?kg~(-1)?d~(-1)of nitrogen. Group A patients received routine TPN,and group B patients received TPN with?-3 fish oil fat emulsion 1-2 ml?kg~(-1)?d~(-1),and both regimes lasted for 7 days.The levels of serum tumor necrosis factor-?(TNF-?),interleukin-1(IL-1)and IL-6 were checked before the treatment,and on the 1st,3rd and 7th day after the beginning of the treatment.The duration in ICU,the incidence of multiple organ dysfunction syndrome(MODS)and the mortality rates in 28 days of the two groups were also assessed.Results Compared with the routine treatment group,the levels of serum TNF-?,IL-1,and IL-6 in the?-3 fish oil fat emulsion+TPN treatment group were lower markedly(P0.05).Conclusion The emulsion of?-3 fish oil fat seems to have a protective effect on patients with SIRS through decreasing the levels of serum TNF-?,IL-1 and IL-6,thus reducing the incidence of MODS,shortening the ICU stay, and increasing the survival rate of serious patients.