The Effection Of Intravenous Fish Oil Combined With Enteral Nutrition To The Patients Of NRS2002≥3 After Abdominal Surgery

Objective:Investigate of intravenous and enteral nutrition of fish oil on NRS2002≥3 after abdominal surgery in patients about inflammatory cytokines, intestinal function and clinical outcome.Methods:Select 40 patients from the Second Affiliated Hospital surgical treatment of Kunming Medical College from September 2010 to March 2011, who received NRS2002≥3 and elective abdominal surgery, of which 10 patients with cholecystectomy,12 patients with bile duct exploration lithotomy,10 patients with left hepatic lobectomy,8 patients with colorectal cancer radical surgery. Depending on the types of surgery patients were randomly divided into control group with 20(5:6:5:4) patients and the fish oil group with 20(5:6:5:4) patients. All the patients were abdominal surgery under general anesthesia.After operation the supplement of the two groups of patients by early enteral nutrition and parenteral nutrition increases by 2-3d transition to full enteral nutrition, the units weight supplied equal heat and nitrogen (PN+EN). Take suction the two groups of patients'plasma when preoperative 1d,postoperative 1 d and postoperative 6d,measure the concentration of blood IL-10,TNF-α,D-lactate; Recorded the first time of postoperative anal exhaust,complications and the length after operative.Results:1. TNF-α, IL-10, D-lactic acid(1)TNF-α ①Control group compared in groups:Patients with postoperative 1d and preoperative 1d compared have significant statistically difference(P<0.01), postoperative 6d and preoperative 1d compared have significant difference(P<0.05); Postoperative 6d and postoperative 1d compared have significant statistically difference(P<0.01). The TNF-αof postoperative 1d patients of control group increased significantly after surgery,and not yet returned to preoperation levels.②Fish oil group compared in groups:Patients with postoperative 1d and preoperative 1d compared have significant statistically difference(P<0.01), postoperative 6d and preoperative 1d compared have no statistically difference(P>0.05); Postoperative 6d and postoperative 1d compared have significant statistically difference(P<0.01). The TNF-αof postoperative 1d patients offish oil group increased significantly after surgery, and not yet returned to preoperation levels.③Comparison between the two groups:Two groups of patients preoperative 1d and postoperative 1d have no significant difference(P>0.05), postoperative 6d two groups of patients compared have statistically difference(P<0.05). Patients in both groups were lower then postoperative Id, fish oil group decreased significantly.(2)IL-10①Control group compared in groups:Patients with postoperative 1d and preoperative Id compared have significant statistically difference(P<0.01), postoperative 6d and preoperative Id compared have significant statistically difference(P<0.01); Postoperative 6d and postoperative Id compared have significant statistically difference(P<0.01). The IL-10 of postoperative 1d patients of control group increased significantly after surgery, postoperative 6d were higher then preoperation 1 d levels.②Fish oil group compared in groups:Patients with postoperative 1d and preoperative 1d compared have significant statistically difference(P<0.01), postoperative 6d and preoperative 1d compared have significant statistically difference(P<0.01); Postoperative 6d and postoperative 1d compared have significant statistically difference(P<0.01). The IL-10 of postoperative 1d patients of control group increased significantly after surgery, postoperative 6d were higher then preoperation Id levels.③Comparison between the two groups:Two groups of patients preoperative 1d and postoperative 1d have no significant difference(P>0.05), postoperative 6d two groups of patients compared have statistically difference(P<0.05). Patients in both groups were high, control group increased significantly.(3) D-lactic acid①Control group compared in groups:Patients with postoperative 1d and preoperative 1d compared have significant statistically difference(P<0.01), postoperative 6d and preoperative 1d compared have significant statistically difference(P<0.01); Postoperative 6d and postoperative 1d compared have no statistically difference(P>0.05). Postoperative 1d control group of D-lactic increased significantly, postoperative 6d and postoperative 1d compared have no significantly decrease.②Fish oil group compared in groups:Patients with postoperative 1d and preoperative 1d compared have significant statistically difference(P<0.01), postoperative 6d and preoperative 1d compared have significant statistically difference(P<0.01); Postoperative 6d and postoperative Id compared have statistically difference(P<0.05). The patients of fish oil group postoperative Id increased significantly, postoperative 6d compared with postoperative 1d have statistically decrease, but not yet returned to preoperation levels.③Comparison between the two groups:Two groups of patients preoperative 1d and postoperative 1d have no significant difference(P>0.05), postoperative 6d two groups of patients compared have statistically difference(P<0.05). Patients in both groups were lower then postoperative 1d, fish oil group decreased significantly.2. Clinical parametersThe incidence of postoperative complications compared have no statistically difference(P>0.05), the two groups compared the incidence of infectious complications have significantly(P<0.05), two groups of patients with complicated non-infectious the incidence of disease compared with no significant difference(P>0.05); Compared Exhaust time have significant statistically difference(P<0.05); Postoperative hospital stay was statistically significant differences(P<0.05).Conclusions:1. NRS2002≥3 patients after abdominal surgery have inflammation, fish oil can reduce the levels of inflammatory mediators;2. Intravenous fish oil and enteral nutrition can reduce the NRS2002≥3 of patients'D-lactate levels after abdominal surgery, and improve the intestinal mucosa barrier function, and promote recovery of intestinal function;3. Intravenous fish oil and enteral nutrition can reduce the NRS2002≥3 patients after abdominal surgery for the first time the exhaust time and postoperative hospital stay, and reduce postoperative infectious complications and improve clinical outcome.