切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 136 -139. doi: 10.3877/cma.j.issn.1674-6880.2024.02.008

短篇论著

ω-3鱼油脂肪乳注射液在脓毒症患者中的应用:前瞻性、随机对照、先导试验
冯芳1,(), 陈宇1, 杨静1, 满珂1, 蔡红燕1, 李群1   
  1. 1. 730030 兰州,兰州大学第二医院重症医学科
  • 收稿日期:2023-08-25 出版日期:2024-04-30
  • 通信作者: 冯芳
  • 基金资助:
    甘肃省自然科学基金项目(23JRRA0965); 兰州大学第二医院(第二临床医学院)"萃英科技创新"计划项目(CY2021-BJ-A10)

Application of omega-3 fish oil fat emulsion injection in patients with sepsis: a prospective, randomized controlled, and pilot trial

Fang Feng(), Yu Chen, Jing Yang   

  • Received:2023-08-25 Published:2024-04-30
  • Corresponding author: Fang Feng
引用本文:

冯芳, 陈宇, 杨静, 满珂, 蔡红燕, 李群. ω-3鱼油脂肪乳注射液在脓毒症患者中的应用:前瞻性、随机对照、先导试验[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(02): 136-139.

Fang Feng, Yu Chen, Jing Yang. Application of omega-3 fish oil fat emulsion injection in patients with sepsis: a prospective, randomized controlled, and pilot trial[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(02): 136-139.

目的

评估在脓毒症患者中使用ω-3鱼油脂肪乳注射液作为辅助治疗的临床效果。

方法

前瞻性纳入2023年1月至6月兰州大学第二医院收治的60例脓毒症患者,分为完全胃肠外营养(TPN)组(对照组,30例)与TPN + ω-3鱼油脂肪乳注射液组(试验组,30例)。两组患者入组当天即予以TPN,试验组同时予以10% ω-3鱼油脂肪乳注射液(100 mL/d)输注5 d。收集两组患者的一般资料及输注前、输注后第3天和第5天炎症介质白细胞介素6(IL-6)、IL-8、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)水平。

结果

试验组患者ICU住院日显著短于对照组[(5.8 ± 1.3)d vs.(7.5 ± 2.2)d,t = 4.291,P = 0.021]。两组患者输注前及输注后第3天、第5天IL-6、IL-8、TNF-α及CRP水平比较,差异均有统计学意义(F = 4.197、7.961、6.238、5.992,P = 0.032、0.002、0.006、0.021)。进一步两两比较发现,试验组患者输注后第3天和第5天IL-6、IL-8、TNF-α及CRP水平均较同组输注前显著降低,且输注后第5天均更低(P均< 0.05);对照组患者输注后第5天IL-6、IL-8、TNF-α及CRP水平均较同组输注前显著降低(P均< 0.05);此外,试验组患者输注后第5天IL-6、IL-8、TNF-α及CRP水平均较对照组同时间点更低(P均< 0.05)。

结论

ω-3鱼油脂肪乳注射液在脓毒症患者中的应用是有效的,可早期抑制过度的机体炎症反应,从而减轻脓毒症对机体的损害,缩短脓毒症患者ICU住院日。

表1 两组脓毒症患者一般资料比较( ± s
表2 两组脓毒症患者实验室炎症指标比较( ± s
1
Vincent JL. Current sepsis therapeutics[J]. EBioMedicine, 2022 (86): 104318.
2
Lakbar I, Munoz M, Pauly V, et al. Septic shock: incidence, mortality and hospital readmission rates in French intensive care units from 2014 to 2018[J]. Anaesth Crit Care Pain Med, 2022, 41 (3): 101082.
3
Lakbar I, Einav S, Lalevée N, et al. Interactions between gender and sepsis-implications for the future[J]. Microorganisms, 2023, 11 (3): 746.
4
陈敏,袁佳辉,郭冬阳,等. CXC趋化因子配体12/CXC趋化因子受体4轴在脓毒症中的研究进展[J/CD].中华危重症医学杂志(电子版)202013(3):225-228.
5
Zaloga GP. Narrative review of n-3 polyunsaturated fatty acid supplementation upon immune functions, resolution molecules and lipid peroxidation[J]. Nutrients, 2021, 13 (2): 662.
6
Xu B, Xu Z, Xu D, et al. Effect of n-3 polyunsaturated fatty acids on ischemic heart disease and cardiometabolic risk factors: a two-sample Mendelian randomization study[J]. BMC Cardiovasc Disord, 2021, 21 (1): 532.
7
Yan CH, Rathor A, Krook K, et al. Effect of omega-3 supplementation in patients with smell dysfunction following endoscopic sellar and parasellar tumor resection: a multicenter prospective randomized controlled trial[J]. Neurosurgery, 2020, 87 (2): E91-E98.
8
Ying Q Croyal M, Chan DC, et al. Effect of omega-3 fatty acid supplementation on the postprandial metabolism of apolipoprotein (a) in familial hypercholesterolemia[J]. J Atheroscler Thromb, 2023, 30 (3): 274-286.
9
中华医学会肠外肠内营养学分会.鱼油脂肪乳剂临床应用中国专家共识(2022版)[J].中华消化外科杂志202221(10):1313-1325.
10
Yokote K, Niwa K, Hakoda T, et al. Short-term efficacy (at 12 weeks) and long-term safety (up to 52 weeks) of omega-3 free fatty acids (AZD0585) for the treatment of Japanese patients with dyslipidemia-a randomized, double-blind, placebo-controlled, phase III study[J]. Circ J, 2020, 84 (6): 994-1003.
11
Yuan M, Zhang Y, Hua T, et al. Omega-3 polyunsaturated fatty acid supplementation improves lipid metabolism and endothelial function by providing a beneficial eicosanoid-pattern in patients with acute myocardial infarction: a randomized, controlled trial[J]. Clin Nutr, 2021, 40 (2): 445-459.
12
Pontes-Arruda A, Martins LF, de Lima SM, et al. Enteral nutrition with eicosapentaenoic acid, γ-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study[J]. Crit Care, 2011, 15 (3): R144.
13
Rice TW, Wheeler AP, Thompson BT, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury[J]. JAMA, 2011, 306 (14): 1574-1581.
14
Sungurtekin H, Degirmenci S, Sungurtekin U, et al. Comparison of the effects of different intravenous fat emulsions in patients with systemic inflammatory response syndrome and sepsis[J]. Nutr Clin Pract, 2011, 26 (6): 665-671.
15
Choudhury A, Kumar M, Sharma BC, et al. Systemic inflammatory response syndrome in acute-on-chronic liver failure: relevance of 'golden window': a prospective study[J]. J Gastroenterol Hepatol, 2017, 32 (12): 1989-1997.
16
Mayer K, Gokorsch S, Fegbeutel C, et al. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis[J]. Am J Respir Crit Care Med, 2003, 167 (10): 1321-1328.
17
Pradelli L, Klek S, Mayer K, et al. Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis[J]. Crit Care, 2020, 24 (1): 634.
18
田涛,李幼生.脓毒症相关肝损害研究进展[J/CD].中华危重症医学杂志(电子版)202114(2):165-167.
19
Hall TC, Bilku DK, Neal CP, et al. The impact of an omega-3 fatty acid rich lipid emulsion on fatty acid profiles in critically ill septic patients[J]. Prostaglandins Leukot Essent Fatty Acids, 2016 (112): 1-11.
20
Donoghue V, Schleicher GK, Spruyt MGL, et al. Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: a randomised control trial (Foil fact)[J]. Clin Nutr, 2019, 38 (6): 2583-2591.
21
Schwarzkopf KA, Queck A, Thomas D, et al. Omega-3 and -6 fatty acid plasma levels are not associated with liver cirrhosis-associated systemic inflammation[J]. PLoS One, 2019 14 (1): e0211537.
22
Kulkarni AV, Anand L, Vyas AK, et al. Omega-3 fatty acid lipid emulsions are safe and effective in reducing endotoxemia and sepsis in acute-on-chronic liver failure: an open-label randomized controlled trial[J]. J Gastroenterol Hepatol, 2021, 36 (7): 1953-1961.
[1] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[2] 杨瑾, 刘雪克, 张媛媛, 金钧, 韦瑶. 肠道微生物来源石胆酸对脓毒症相关肝损伤的保护作用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 265-274.
[3] 张霞, 张瑞, 郑志波, 张勤. 紫草素调控乳酸化修饰和线粒体功能改善脓毒症心肌病小鼠的预后[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 275-284.
[4] 张婧琦, 江洋, 孙佳璐, 唐兴喆, 赵宇飞, 崔颖, 李信响, 戴景月, 傅琳, 彭新桂. 基于肾周CT特征结合血清肌酐水平探讨脓毒症伴急性肾损伤的早期识别[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 285-292.
[5] 李振翮, 魏长青, 甄国栋, 李振富. 脓毒症并发急性呼吸窘迫综合征患者血清S1P、Wnt5a变化及其临床意义[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 293-300.
[6] 唐亦骁, 陈峻, 连正星, 胡海涛, 鲁迪, 徐骁, 卫强. 白果内酯对小鼠肝缺血再灌注损伤保护作用研究[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 278-282.
[7] 李智, 冯芸. NF-κB 与MAPK 信号通路及其潜在治疗靶点在急性呼吸窘迫综合征中的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 840-843.
[8] 向阳, 史黎炜, 肖月, 邱海波, 杨毅, 刘松桥, 邱英鹏, 张莹. 连续性肾脏替代治疗在我国五地区重症医学科的效率分析[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 358-363.
[9] 赵佳钰, 邱英鹏, 刘松桥, 杨毅, 张凌, 于湘友, 秦秉玉, 邱海波, 史黎炜, 刘克军, 蒲莹莹, 陈子扬, 赵羽西, 刘永军, 肖月. 连续性肾脏替代治疗在我国五地区重症医学科的应用现况[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 364-374.
[10] 黄立, 吴朝, 蔡君婷, 艾宇航, 徐道妙, 刘志勇, 张丽娜. 思政背景下重症医学专业教学实践探讨[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 375-378.
[11] 陈曦, 吴宗盛, 郑明珠, 邱海波. 胸腺萎缩在脓毒症免疫紊乱中的研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 379-383.
[12] 杨翔, 郭兰骐, 谢剑锋, 邱海波. 转录组学在脓毒症诊疗中的临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 384-388.
[13] 唐韵, 杨小博, 余愿, 舒化青, 尚游. 苯磺酸瑞马唑仑的临床研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 389-393.
[14] 姚庆春, 魏光晨, 孟玫. 关注ICU 患者接受的非必要血液检测[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 329-333.
[15] 陈惠英, 邱敏珊, 邵汉权. 脓毒症诱发肠黏膜屏障功能损伤的风险因素模型构建与应用效果[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 448-452.
阅读次数
全文


摘要