含魚油脂肪乳劑對腸胃道手術患者發炎反應與臨床結果的影響

歷經腸胃手術病患，因處於發炎狀態下造成免疫功能受損，成為產生感染併發症的高危險群，近來富含ω-3多元不飽和脂肪酸的魚油被添加於新開發的脂肪乳劑中，魚油富含二十碳五烯酸(EPA)與二十二碳六烯酸(DHA)具有調節免疫功能與抗發炎的作用，因此本研究在腸胃道術後病患的靜脈營養給予含魚油脂肪乳劑，以探討魚油的補充對腸胃道術後患者發炎反應變化、營養狀態及臨床表現是否有正向的影響。本研究篩選台南市立醫院接受腸胃道手術患者40位，單盲隨機分配為魚油組(SMOFlipid 20%)與對照組(Lipovenoes MCT 20%)，術後給予5天的靜脈營養支持；於介入前後各抽取一次血液樣本，分析相關生化值及以ELISA分析促發炎細胞激素Shh、TNF-α、IL-1β、IL-6和IL-10，並紀錄臨床表現呼吸器使用天數、感染發生率、ICU入住天數與住院天數。結果顯示，魚油脂肪乳劑對於營養狀態改善與臨床結果無統計上差異；在發炎反應方面，使用魚油脂肪乳劑者其促發炎激素Shh與IL-6有顯著性下降 (p <0.05)，且下降後的Shh與IL-1β以及下降後的IL-6與WBC、CRP皆有正相關 (p<0.01)，顯示使用魚油脂肪乳劑可以改善腸胃道患者術後的發炎反應。

Patients undergoing gastrointestinal surgery are at increased risk of developing complications due to the inflammatory state will impair the immune function. Recently, fish oil with rich of ω-3 polyunsaturated fatty acids is added to the newly developed lipid emulsion. Eicosapentaenoic acid(EPA) and docosahexaenoic acid(DHA) within fish oil are capable of regulating immune function and anti-inflammatory effects. The purpose ofthis study is to explore the influence of the postoperative parenteral nutrition with lipid emulsion containing fish oil on patients who received gastrointestinal surgery. The changes of inflammatory response, nutrition status, and the clinical outcomes will be observed as well. Forty patients who received gastrointestinal surgery in Tainan Municipal Hospital were included in this study. These patients were single-blind randomly allocated into either the fish oil group (SMOFlipid 20%) or the control group (Lipovenoes the MCT 20%). The parenteral nutrition had been given for five days after the surgery. The blood samples were examined before and after the therapy. Related biochemical values, pro-inflammatory cytokines of Shh, TNF-α, IL-1β, IL-6 and IL-10 were analyzed. Performances ofventilator days, incidence of infection, ICU stay days and days of hospitalization also were recorded. According to the results, there was no significantly different in nutrition status and clinical outcomes. However, in the fish oil group the level of proinflammatory cytokines of Shh and IL-6 decreased after therapy (p <0.05). There was a positive correlation between shh and IL-1β, and a positive correlation between L-6 and WBC, CRP(p<0.01). We concluded that the postoperative parenteral nutrition lipid emulsion containing fish oil can improve the inflammatory response for patients who received gastrointestinal surgery.