Aiko Satoshi, Yoshizumi Yutaka, Tsuwano Shinichi, Shimanouchi Masaoki, Sugiura Yoshiaki, Maehara Tadaaki
Department of Surgery II, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
JPEN J Parenter Enteral Nutr. 2005 May-Jun;29(3):141-7. doi: 10.1177/0148607105029003141.
We investigated whether supplementation of enteral nutrition (EN) with omega-3 polyunsaturated acids (PUFAs) affected platelet aggregation, coagulation activity, and inflammatory response in the early stages after esophageal cancer surgery.
Twenty-eight patients with esophageal cancer who underwent the same surgical procedure were selected for this study. All patients received EN, which was started immediately after the operation and was increased to a maximum volume of 1500 ml/day by the third postoperative day (POD). Eleven patients received a conventional EN formula (Ensure Liquid), while the remaining 17 patients received a different formula rich in omega-3 PUFAs (Racol [RAC]). Several markers of coagulation and fibrinolysis were determined in POD 2, while the concentrations of interleukin (IL)-6, IL-8, 6-keto-PGF1alpha and thromboxane B2 were determined on PODs 1, 3, and 5.
A total of 27 patients completed the study, 11 in the Ensure Liquid group and 16 in the RAC group. Administration of RAC significantly inhibited the postoperative decrease in platelet count. The level of D-dimer was attenuated significantly in the RAC group. Plasma IL-8 levels were decreased significantly in the RAC group on PODs 1 and 3. The anti-inflammatory effects of omega-3 PUFAs were confirmed by the clinical findings of lower body temperature. The plasma concentration of 6-keto-PFG1alpha also tended to decrease in the RAC group with a significant difference on POD 5.
Early EN with a large amount of omega-3 PUFAs in reduced platelet aggregation, coagulation activity, and cytokine production. All these effects would be expected to be beneficial in patients following esophageal cancer surgery. The clinical significance of the changes in eicosanoid production remains to be established.
我们研究了在食管癌手术后早期，肠内营养（EN）补充ω-3多不饱和脂肪酸（PUFAs）是否会影响血小板聚集、凝血活性和炎症反应。
本研究选取了28例行相同手术的食管癌患者。所有患者均接受EN，术后立即开始，术后第3天（POD）将摄入量增加至最大量1500ml/天。11例患者接受传统EN配方（安素液），其余17例患者接受富含ω-3 PUFAs的不同配方（瑞卡福[RAC]）。在POD 2测定了几种凝血和纤维蛋白溶解标志物，而在POD 1、3和5测定了白细胞介素（IL）-6、IL-8、6-酮-前列腺素F1α和血栓素B2的浓度。
共有27例患者完成研究，安素液组11例，RAC组16例。给予RAC显著抑制了术后血小板计数的下降。RAC组D-二聚体水平显著降低。RAC组在POD 1和3时血浆IL-8水平显著降低。较低体温的临床发现证实了ω-3 PUFAs的抗炎作用。RAC组6-酮-前列腺素F1α的血浆浓度也有下降趋势，在POD 5时有显著差异。
早期给予大量ω-3 PUFAs的EN可降低血小板聚集、凝血活性和细胞因子产生。所有这些作用预计对食管癌手术后的患者有益。类花生酸产生变化的临床意义仍有待确定。
