Intervention Study Of Fish Oil On Complications And Inflammatory Mediators In Patients Who Have The Nutritional Risk After Major Abdominal Surgery

ObjectiveDiscussing the change of complications and inflammatory mediators in patients who have the nutritional risk after intervention of fish oil after major abdominal surgery.MethodsSelecting 30 cases patients who has received radical surgery of gastrointestinal tumors and extrahepatic bile duct exploration+left lobectomy in the Second Affiliated Hospital of Kunming Medical College hospital general surgery from September 2010 to March 2011, and whose NRS2002≥3 points the day after surgery.The 30 cases patients were randomly divided into fish oil group,15 patients (6:9) and the control group 15 patients (5:10). The patients of two groups were treated with isocaloric and isonitrogenous energy emulsion intralipid of 3L TPN bags that is imported by CV treatment (1.2g/kg/d Lineng intralipid +3g/kg/d of glucose+0.2g/kg/d) after surgery.In which fish oil emulsion containing fish oil 0.2g/kg/d and 1.0g/kg/d Lineng intralipid and control group containin 1.2g/kg/d Lineng intralipid, and the patients of two groups were treated with electrolyte, vitamin and trace Elements equal, and adjusting it according to laboratory tests. Using of parenteral nutrition less than 5 days, and other routine treatment is clinics. All the patients were abdominal surgery under general anesthesia. Urinary catheter was uniformly placed preoperative, and was removed within 24 hours after surgery. The patients of two groups after surgery the same day POSSUM score, respectively, before surgery first day, after first day. sixth day measured in peripheral venous blood drawn fasting IL-6, TNF-a concentration, records related complications.One patient of fish oil group opts out of testing during the experiment in third days after surgery. Results1.POSSUM scoreFish oil group and the control group no significant difference in POSSUM score (P> 0.05).2.NRS2002 scoreAll 30 patients with major abdominal surgery, patients of NRS2002=5 points were 4 cases (13.3%); the patients of NRS2002= 4 points were 7 cases (23.3%); patients of NRS2002=3 points were 19 (63.3%).3. Serum concentrations of inflammatory mediators(1) Serum IL-6 concentrations:①The concentration of IL-6 group compared:Fish oil in patients after surgery compared with preoperative first day significant difference (P<0.01), postoperative first day and sixth day after surgery were significantly different than (P<0.01), surgery sixth day after compared with before surgery were no significant differences (P> 0.05). Fish oil in patients with postoperative first day IL-6 concentration was significantly increased sixth day after operation has been restored to the preoperative level. Control group, patients with preoperative first day were significantly different than (P<0.01), postoperative first day compared with the sixth day the difference was not statistically significant (P> 0.05), sixth day after surgery and preoperative statistically significant difference compared (P<0.05). Control group patients after the first day IL-6 concentration was significantly increased sixth day after surgery has not yet recovered to the preoperative level (P<0.05).②Comparison of IL-6 between the two groups:preoperative IL-6 difference between the two groups was not significant (P> 0.05). Postoperative first day, sixth day fish oil group compared with the control group no significant difference (P> 0.05).(2) changes in serum concentrations of TNF-a:①concentrations of TNF-a group compared:Fish oil in patients after surgery compared with preoperative first day significant difference (P<0.01), sixth day after surgery compared with before surgery were significantly different (P<0.01), after Section first day to sixth day compared with the postoperative difference (P<0.01); Fish oil in patients with postoperative first day TNF-a concentration, sixth day after surgery has not yet returned to preoperative levels. first day after operation in control group were compared with preoperative significant difference (P<0.01), postoperative first day sixth day compared with the postoperative difference (P<0.01), postoperative patients compared with the preoperative sixth day difference (P<0.01); control group patients after the first first day TNF-a concentration, sixth day after surgery has not yet recovered to the preoperative level (P<0.01).②TNF-a levels between groups comparison:before and after the first two groups of TNF-a first day no difference (P> 0.05). Section sixth day fish oil group compared with the control group difference (P<0.05).4. Changes in incidence of postoperative complications:Complication rate in fish oil group compared with the control group were significantly different (P<0.01), in which the incidence of infectious complications in both groups there was significant difference in the incidence of non-infectious complications were no significant differences.5. Relationship with NRS2002 scores and Complications:The incidence of complications (infectious complications) was 75%(50%) in patients of NRS2002=5 points; Complications (infectious complications) of Rate was 42.9%(42.9%) in patients of NRS2002=4 points; Complications (infectious complications) rate was 15.8%(10.5%) in patients of NRS2002=3 points.Conclusion1. Nutritious after major abdominal surgery patients at risk of early TNF-a and IL-6 levels increased significantly;2. Fish oil can significantly reduce nutritional risk patients after major abdominal surgery the level of TNF-a, IL-6 on the lower has a role;3. Fish oil makes complications of patients with nutritional risk after major abdominal surgery significantly reduce, of which reduces the infectious complications mainly;4. The higher NRS2002 score, The higher complications (infectious complications) incidence.