The Effect That The Total Parenteral Nutrition Containing Fish Oil To The Patients Who After Major Surgery On The Abdomen With Stress Hyperglycemia

ObjectiveDiscussing the change of stress hyperglycemia and insulin dose of used to control the postoperative high blood sugar in patients who have the total parenteral nutrition with fish oil after major abdominal surgery,and to explore its possible mechanism.MethodsSelecting40cases patients who has received major abdominal surgery in the Second Affiliated Hospital of Kunming Medical College hospital general surgery from May2011to March2012.The40case patients were randomly divided into fish oil group(20patients) and the control group(20patients). The patients of two groups were treated with isocaloric and isonitrogenous energy emulsion intralipid of3L TPN bags that is imported by CV treatment1.2g/kg/d Lineng intralipid+3g/kg/d of glucose+0.2g/kg/d)after surgery.In which fish oil emulsion containing fish oil0.2g/kg/d and l.Og/kg/d Lineng intralipid and control group containin1.2g/kg/d lineng intralipid,and adjusting it according to laboratory test.Using of parenteral nutrition less than7days,and other routine treatment is clinics.The patients of two groups will to measured in peripheral venous blood drawn FPG,FINS,TNF-a concentration before surgery fist day,after fist day,second day,third day and seventh day.According to the HOME formula,we calculated the index of IR and recorded the dose of insulin.The postoperative complications has detailed records according to the definitions of diagnose.The patients of the two groups successfully completed the trial,no drop-out case and the whole process has runned with the principle of the single-blind.ResultsThe postoperative concentrations of FPG and FINS. The concentrations of FPG and FINS group compared:Fish oil in patients after surgery fist day,second day,third day compared with preoperative first day significant difference(P<0.01),surgery seventh day after compared with before surgery were no significant differences(P>0.05).Control group,The patients after surgery fist day,second day,third day compared with preoperative first day significant difference(P<0.01),surgery seventh day after compared with before surgery were no significant differences(P>0.05).Comparison of FPG and FINS between the two groups:preoperative,after surgery fist day,seventh day FPG and FINS difference between the two groups was not significant difference(P>0.05).After surgery second day,third day FPG and FINS difference between the two groups was significant difference(P<0.01).Changes in serum consentrations of TNF-a:(2)The concentrations of TNF-a group compared:Fish oil patients after surgery first,second,third day, seventh day compared with preoperative first day significant difference(P<0.01).In the control group,The patients after surgery fist day,second day,third day, seventh day compared with preoperative first day significant difference(P <0.01)(2)The TNF-a levels between groups comparison:preoperative,after surgery fist day,the TNF-a levels difference between the two groups was not significant difference(P>0.05).After surgery second day,third day, seventh day,the TNF-a levels difference between the two groups was significant difference(P<0.01). Changes in IR of postoperative patients:(1)The IR group compared:Fish oil patients after surgery first,second,third day compared with preoperative first day significant difference(P<0.01), seventh day after surgery compared with before surgery no significant difference(P>0.05).In the control group,The patients after surgery fist day.second day,third day, seventh day compared with preoperative first day significant difference(P<0.01)(2)The IR between groups comparison:preoperative,after surgery fist day the IR difference between the two groups was not significant difference(P>0.05).After surgery second day,third day,,seventh day the IR difference between the two groups was significant difference(P<0.01).Changes in the dose of insulin used to control stress hyperglycemia between the two groups:The dose of insulin used to control stress hyperglycemia in fish oil group compared with the control group were significantly different(P<0.01).5.Changes in incidence of postoperative complications:complication rate in fish oil group compared with the control group were significantly different(P<0.01).Conclusion1.There is a phenomenon of stress hyperglycemia in patients who after major surgery on abdomen.The Cytokines(TNF-a) and IR is resistant to this phenomenon.2.The total parenteral nutrition with fish oil can reduce the levels of stress hyperglycemia in patients who after major surgery on abdomen by reduce cytokine(TNF-a) and insulin receptor resistance,and also can reduce the dose of insulin used to control the postoperative hyperglycemia.lt is the effectiveness that assist the insulin therapy,thereby improving the clinical outcomes of postoperative patients.