Department of Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
Ir J Med Sci. 2012 Dec;181(4):453-7. doi: 10.1007/s11845-012-0813-x. Epub 2012 Mar 22.
The term "enhanced recovery programme (ERP)" means applying defined protocols to augment the recovery of patients following surgery. Inflammation is body's response to insults such as infection, injury and surgical procedures. Inflammatory mediators whose function is initially protective may cause undesirable consequences, if the response is unnecessarily prolonged. The principle effects of ERP result from the reduction of the profound stress which results following major surgical procedures.
A Pubmed literature search was undertaken using the keywords enhanced recovery, surgery and omega-3. The primary endpoint was whether the addition of omega-3 to ERP improved morbidity and mortality.
Nine randomised trials examining the effect of omega-3 enriched diets following surgery were analysed. Inclusion of omega-3 helps in maintaining a positive nitrogen balance, overcome immune dysfunction, lower the incidence of post-operative infections with the consequence of reduced morbidity and mortality.
The provision of early or continuous nutrition is one of the cornerstones of an ERP. A theoretically ideal regimen would provide an energy substrate and protein and contain a component which would limit inappropriate inflammation. The beneficial role of omega-3 results from a number of effects which limit the inflammatory response, principally by influencing the production of eicosanoids and modulating cytokines. They also enhance cell-mediated immunity and preserve immune function better than standard dietary formulations. Although ERPs have already produced significant progress, there is sufficient evidence to suggest that the provision of omega-3 fatty acids may result in further improvements.
“加速康复方案（ERP）”是指应用特定方案来促进术后患者的康复。炎症是机体对感染、损伤和手术等刺激的反应。最初具有保护作用的炎症介质，如果反应过度，可能会产生不良后果。ERP 的主要作用是减轻重大手术引起的深度应激。
使用“增强恢复、手术和欧米伽-3”等关键词在 Pubmed 数据库中进行文献检索。主要终点是欧米伽-3 联合 ERP 是否能改善发病率和死亡率。
分析了 9 项关于手术后欧米伽-3 丰富饮食影响的随机试验。摄入欧米伽-3 有助于维持正氮平衡、克服免疫功能障碍、降低术后感染发生率，从而降低发病率和死亡率。
早期或持续提供营养是 ERP 的基石之一。一种理论上理想的方案将提供能量底物和蛋白质，并包含一种可以限制不当炎症的成分。欧米伽-3 的有益作用源于多种限制炎症反应的作用，主要通过影响类二十烷酸的产生和调节细胞因子。它们还能增强细胞介导的免疫功能，比标准饮食配方更好地维持免疫功能。尽管 ERP 已经取得了显著进展，但有足够的证据表明，提供欧米伽-3 脂肪酸可能会进一步改善。
