术前给予ω-3鱼油脂肪酸降低恶性梗阻性黄疸患者术后胆道感染发生的效果
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摘要
目的:探讨术前给予ω-3鱼油脂肪酸降低恶性梗阻性黄疸患者术后感染发生的效果。方法:采用前瞻性研究方法,选择2013年9月到2016年2月在我科住院的恶性梗阻性黄疸患者156例,根据入院顺序随机分为观察组与对照组各78例,两组患者均行PTCD~+胆道支架植入术治疗,观察组患者术前5d开始口服ω-3鱼油脂肪酸,对照组患者术前不用ω-3鱼油脂肪酸。检测两组患者术后1d、术后15dT细胞免疫功能变化,观察与记录术后胆道感染发生率及其肝功能指标。结果:观察组患者术后15d的CD4~+值明显高于术后1d(P<0.05),也明显高于对照组(P<0.05),CD8~+值在组内与组间对比差异都无显著性意义(P>0.05)。两组患者术后1d与术后15d的血清ALT和AST在组内与组间对比差异无显著性意义(P>0.05)。观察组患者术后15d的感染发生率为5.6%,对照组为25.0%,观察组患者术后感染发生率明显少于对照组(P<0.05)。观察组与对照组的死亡率分别为2.56%(2/78)和5.13%(4/78),差异无显著性意义(P>0.05)。结论:术前给予ω-3鱼油脂肪酸能改善胆道支架植入术后患者的细胞免疫功能,从而降低术后感染的发生率。
Objective:To investigate the effects of preoperative administeration of ω-3 fatty acids in fish on postoperative biliary tract infection in patients with malignant obstructive jaundice.Methods:Using the prospe-ctive study method,156 cases from September 2013 to February 2016 in our department for treatment of malignant obstructive jaundice patients were randomly divided into observation group and control group with 78 cases in each group according to the order of admission,two groups were given biliary stent implantation.The observation group were given oral ω-3 fish oil fatty acids before 5 days,and the control group not given.De-tecting the changes of immune function of 15 dT cells in 1D after operati-on,the postoperative infection incidence and the changes of the related index were observed and recorded.Results:The 15 d value of CD4~+ in the observation group was significantly higher than that of postoperative 1D and control group(P<0.05)and there was no significant difference between the CD8~+ group and the control group(P>0.05);There was no signif-icant difference between the two groups in postoperative 1D and 15 d abo-ut the serum ALT and AST(P>0.05).The incidence of 15 d infection in the observation group was less than that of the control group(5.6%vs 25.0%,P<0.05);The mortality rate of the observation group and the control group were 2.56%(2/78) and 5.13%(4/78),respectly,the difference was not statistically significant(P>0.05).Conclusion:preoperative administ-eration of ω-3 fatty acids in fish could improve the cellular immune func-tion of patients after biliary stent implantation.so,it could reduce the inci-dence of postoperative infection.
Objective:To investigate the effects of preoperative administeration of ω-3 fatty acids in fish on postoperative biliary tract infection in patients with malignant obstructive jaundice.Methods:Using the prospe-ctive study method,156 cases from September 2013 to February 2016 in our department for treatment of malignant obstructive jaundice patients were randomly divided into observation group and control group with 78 cases in each group according to the order of admission,two groups were given biliary stent implantation.The observation group were given oral ω-3 fish oil fatty acids before 5 days,and the control group not given.De-tecting the changes of immune function of 15 dT cells in 1D after operati-on,the postoperative infection incidence and the changes of the related index were observed and recorded.Results:The 15 d value of CD4~+ in the observation group was significantly higher than that of postoperative 1D and control group(P<0.05)and there was no significant difference between the CD8~+ group and the control group(P>0.05);There was no signif-icant difference between the two groups in postoperative 1D and 15 d abo-ut the serum ALT and AST(P>0.05).The incidence of 15 d infection in the observation group was less than that of the control group(5.6%vs 25.0%,P<0.05);The mortality rate of the observation group and the control group were 2.56%(2/78) and 5.13%(4/78),respectly,the difference was not statistically significant(P>0.05).Conclusion:preoperative administ-eration of ω-3 fatty acids in fish could improve the cellular immune func-tion of patients after biliary stent implantation.so,it could reduce the inci-dence of postoperative infection.
引文
[1]张伟星,陈颖,段晓燕,等内镜下逆行胰胆管造影置放胆道支架治疗恶性梗阻性黄疸98例疗效分析[J]现代生物医学进展,2012,12(11):2080-2084
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[6]邓炳取.ω-3鱼油脂肪乳在重症急性胰腺炎患者中的应用价值分析[J].海南医学院学报,2015,21(7):936-938.
[7]张华东,陈怀生,洪澄英.等.ω3鱼油脂肪酸治疗脓毒症并肠功能障碍的疗效及其对患者免疫功能的影响[J].海南医学,2015,26(9):1265—1267
[8]陈怀生,洪英财,张岸林.等.ω-3鱼油脂肪酸在脓毒症并严重急性胃肠损伤中的应用[J]广东医学,2015,23(14):2234-2237.
[9]陈怀生,洪英财,张华东,等.鱼油脂肪乳对脓毒症并发严重急性胃肠损伤病人的免疫调埋作用[J].肠外与肠内营养,2015,22(3):156-160.
[10]胡国强,陈威.含ω-3鱼油脂肪乳的肠外营养液对胃肠道肿瘤病人术后免疫与炎性因子的影响[J].肠外与肠内营养,2015,22(1):16-19.
[11]钟少东,张琳琳.ω-3鱼油脂肪乳作为肠外营养应用于胃癌术后患者的随机对照研究[J].安徽医学.2015,9(12):1463-1466.
[12]邵峰.杨道贵免疫微生态肠内营养对腹腔感染患者术后胰岛素抵抗和感染并发症的影响[J].中华胃肠外科杂志,2014,17(7):676-679.
[13]Fialkow J.Omega-3 Fatty Acid Formulations in Cardiovascular Disease;Dietary Supplements are Not Substitutes for Prescription Products]J].Am J Cardiovasc Drugs,2016,30(4):99-104.
[14]齐敦峰,李欢送,姜新春.等.S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况影响的临床研究[J].现代生物医学进展,2014.14(1):147-149.
[15]张莹,黄强,张秋红,等.经皮胆道射频消融联合支架植入术后的护理体会[J].介入放射学杂志,2015.22(9):819-821.
[16]王强,赵丽莎,柯要军,等.经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸近期效果观察及影响因素分析[J].解放军医药杂志,2016,13(2):55-58.
[17]杨丽,王俊梅,姜海波,等.恶性梗阻性黄疸的两种微创介入治疗术后并发症比较分析[J].中国现代医生,2015,16(2):36-38.
[18]兰忠民,汤小龙,张建伟.等.中度黄疸患者行术前减黄的前瞻性非随机对照研究[J].中华医学杂志.2015,95(2):93-95.
[19]滕春雨.恶性梗阻性黄疽患者经皮穿刺肝胆管引流术后胆管感染的临床分析及预防研究[J].医学综述,2015,21(11):2107-2108.
[20]顾炯,田开亮,程智礼,等.恶性梗阻性黄疸胰十二指肠切除术前行胆道引流疗效的Meta分析[J].中华消化外科杂志,2015,14(4).298-304.
[2]Monk JM,Liddle DM,Cohen DJ,et al.The delta 6 desaturase knock out mouse reveals that immunomodulatory effects of essential n-6 and n-3 polyunsaturated fatty acids arc both independent of and dependent upon conversion[J].J Nutr Biochem,2016,32(2):29-38.
[3]陈旭.ω-3鱼油脂肪乳对老年革兰阴性菌感染致重症肺炎患者血PCT水平的影响[J].现代中西医结合杂志.2015,22(5):532-533
[4]张红军,常树勋,王晓鹏,等.经皮肝穿刺胆道引流术联合支架植入术对恶性梗阻性黄疸的疗效分析[J].实用医学影像杂志,2015,16(6):476-478.
[5]黄河,潘红梅,郑利荣.ω-3鱼油脂肪乳对肝切除术患者预后的Mela-分析[J].医学临床研究,2015,21(5):944-947.
[6]邓炳取.ω-3鱼油脂肪乳在重症急性胰腺炎患者中的应用价值分析[J].海南医学院学报,2015,21(7):936-938.
[7]张华东,陈怀生,洪澄英.等.ω3鱼油脂肪酸治疗脓毒症并肠功能障碍的疗效及其对患者免疫功能的影响[J].海南医学,2015,26(9):1265—1267
[8]陈怀生,洪英财,张岸林.等.ω-3鱼油脂肪酸在脓毒症并严重急性胃肠损伤中的应用[J]广东医学,2015,23(14):2234-2237.
[9]陈怀生,洪英财,张华东,等.鱼油脂肪乳对脓毒症并发严重急性胃肠损伤病人的免疫调埋作用[J].肠外与肠内营养,2015,22(3):156-160.
[10]胡国强,陈威.含ω-3鱼油脂肪乳的肠外营养液对胃肠道肿瘤病人术后免疫与炎性因子的影响[J].肠外与肠内营养,2015,22(1):16-19.
[11]钟少东,张琳琳.ω-3鱼油脂肪乳作为肠外营养应用于胃癌术后患者的随机对照研究[J].安徽医学.2015,9(12):1463-1466.
[12]邵峰.杨道贵免疫微生态肠内营养对腹腔感染患者术后胰岛素抵抗和感染并发症的影响[J].中华胃肠外科杂志,2014,17(7):676-679.
[13]Fialkow J.Omega-3 Fatty Acid Formulations in Cardiovascular Disease;Dietary Supplements are Not Substitutes for Prescription Products]J].Am J Cardiovasc Drugs,2016,30(4):99-104.
[14]齐敦峰,李欢送,姜新春.等.S-腺苷蛋氨酸对梗阻性黄疸患者术后肝功能及营养状况影响的临床研究[J].现代生物医学进展,2014.14(1):147-149.
[15]张莹,黄强,张秋红,等.经皮胆道射频消融联合支架植入术后的护理体会[J].介入放射学杂志,2015.22(9):819-821.
[16]王强,赵丽莎,柯要军,等.经皮肝穿刺胆管引流术治疗恶性梗阻性黄疸近期效果观察及影响因素分析[J].解放军医药杂志,2016,13(2):55-58.
[17]杨丽,王俊梅,姜海波,等.恶性梗阻性黄疸的两种微创介入治疗术后并发症比较分析[J].中国现代医生,2015,16(2):36-38.
[18]兰忠民,汤小龙,张建伟.等.中度黄疸患者行术前减黄的前瞻性非随机对照研究[J].中华医学杂志.2015,95(2):93-95.
[19]滕春雨.恶性梗阻性黄疽患者经皮穿刺肝胆管引流术后胆管感染的临床分析及预防研究[J].医学综述,2015,21(11):2107-2108.
[20]顾炯,田开亮,程智礼,等.恶性梗阻性黄疸胰十二指肠切除术前行胆道引流疗效的Meta分析[J].中华消化外科杂志,2015,14(4).298-304.