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目的探讨术前应用含ω-3不饱和脂肪酸的肠内营养制剂对胃癌患者营养状况和炎症因子水平的影响,并对其进行安全性评价。方法前瞻性纳入2014年1~6月期间四川大学华西医院收治的60例胃癌患者,随机分为试验组(30例)和对照组(30例)。试验组术前以含ω-3不饱和脂肪酸的营养制剂(瑞能)作为肠内营养制剂,对照组进食等热卡等氮的均浆膳,术前均连续服用5 d,至术前1 d。检测患者入院时、术前1 d、术后3 d及术后5 d血清中的炎症因子指标和营养相关指标,检测患者入院时和术前1 d的肝肾功能指标以作为安全性评价指标;记录患者呕吐、腹泻等不良反应,以及术后感染相关并发症的发生情况。结果术后3 d试验组患者的白介素-6(IL-6)和α-1酸性糖蛋白(AAG)水平均低于对照组(P<0.05),术后5 d试验组的C反应蛋白(CRP)水平低于对照组(P<0.05),其余各时点2组患者的各指标比较差异均无统计学意义(P>0.05)。在肠内营养支持期间,试验组患者发生腹胀1例,腹泻1例,对照组患者未出现腹胀、腹泻等不适。2组患者的不良反应发生率比较差异无统计学意义(P>0.05)。术后试验组发生切口感染1例(3.3%);对照组发生切口感染3例(10.0%),腹腔感染1例(3.3%),尿路感染1例(3.3%),肺部感染2例(6.7%),共计7例(23.3%)。2组患者的腹腔感染、切口感染、尿路感染及肺部感染发生率比较差异均无统计学意义(P>0.05),但试验组的总并发症发生率低于对照组(P=0.026)。结论术前应用含ω-3不饱和脂肪酸的营养制剂降低了胃癌患者术后的感染并发症发生率,且安全性较高。
Objective To investigate the effect of preoperative enteral nutrition with omega-3 unsaturated fatty acids on nutritional status and inflammatory cytokines in gastric cancer patients, and to evaluate its safety. Methods Sixty patients with gastric cancer admitted to West China Hospital of Sichuan University from January to June 2014 were prospectively enrolled and randomly divided into experimental group (30 cases) and control group (30 cases). The experimental group before surgery with omega-3 unsaturated fatty acid nutritional preparations (Reneng) as enteral nutrition preparations, the control group to eat such as heat card nitrogen equal meal, preoperative five consecutive days before surgery to preoperative 1 d. The patients were admitted to hospital, 1 d before surgery, 3 d after surgery and 5 d postoperative serum inflammatory cytokines and nutrition-related indicators, detection of patients admitted to hospital and preoperative 1 d liver and kidney function indicators as a safety evaluation index ; Record patients vomiting, diarrhea and other adverse reactions, and postoperative infection related complications. Results The levels of interleukin-6 (IL-6) and α-1 acid glycoprotein (AAG) in the experimental group were significantly lower than those in the control group on the 3rd postoperative day (P <0.05). The levels of C-reactive protein CRP levels were lower than those in the control group (P <0.05). There was no significant difference between the other two groups (P> 0.05). During enteral nutrition support, 1 patient developed abdominal distension and 1 patient developed diarrhea. Patients in the control group did not experience abdominal distension or diarrhea. There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Incision infection occurred in 1 patient (3.3%) in the postoperative test group, 3 (10.0%) in the control group, 1 in the abdominal cavity (3.3%), 1 in the urinary tract (3.3%), 2 in the lung (6.7%), a total of 7 cases (23.3%). There was no significant difference in incidence of abdominal infection, incisional infection, urinary tract infection and pulmonary infection between the two groups (P> 0.05), but the overall complication rate in the experimental group was lower than that in the control group (P = 0.026) . Conclusion Preoperative use of omega-3 unsaturated fatty acid-containing nutritional supplements reduces the incidence of postoperative complications of gastric cancer and is safe.