Manzanares William, Dhaliwal Rupinder, Jurewitsch Brian, Stapleton Renee D, Jeejeebhoy Khursheed N, Heyland Daren K
Department of Critical Care Medicine, Faculty of Medicine, Universidad de la República (UDELAR), Montevideo, Uruguay.
JPEN J Parenter Enteral Nutr. 2014 Jan;38(1):20-8. doi: 10.1177/0148607113486006. Epub 2013 Apr 22.
ω-3 Polyunsaturated fatty acids contained in fish oils (FO) possess major anti-inflammatory, antioxidant, and immunologic properties that could be beneficial during critical illness. We hypothesized that parenteral FO-containing emulsions may improve clinical outcomes in the critically ill.
We searched computerized databases from 1980-2012. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated FO-containing emulsions, either in the context of parenteral nutrition (PN) or enteral nutrition (EN).
A total of 6 RCTs (n = 390 patients) were included; the mean methodological score of all trials was 10 (range, 6-13). When the results of these studies were aggregated, FO-containing emulsions were associated with a trend toward a reduction in mortality (risk ratio [RR], 0.71; 95% confidence interval [CI], 0.49-1.04; P = .08; heterogeneity I (2) = 0%) and a reduction in the duration of mechanical ventilation (weighted mean difference in days [WMD], -1.41; 95% CI, -3.43 to 0.61; P = .17). However, this strategy had no effect on infections (RR, 0.76; 95% CI, 0.42-1.36; P = .35) and intensive care unit length of stay (WMD, -0.46; 95% CI, -4.87 to 3.95; P = .84, heterogeneity I (2) = 75%).
FO-containing lipid emulsions may be able to decrease mortality and ventilation days in the critically ill. However, because of the paucity of clinical data, there is inadequate evidence to recommend the routine use of parenteral FO. Large, rigorously designed RCTs are required to elucidate the efficacy of parenteral FO in the critically ill.
鱼油（FO）中含有的ω-3多不饱和脂肪酸具有主要的抗炎、抗氧化和免疫特性，在危重病期间可能有益。我们假设含鱼油的肠外乳剂可能改善危重病患者的临床结局。
我们检索了1980年至2012年的计算机化数据库。我们纳入了在危重病成年患者中进行的随机对照试验（RCT），这些试验评估了含鱼油的乳剂，无论是在肠外营养（PN）还是肠内营养（EN）的背景下。
共纳入6项RCT（n = 390例患者）；所有试验的平均方法学评分是10分（范围为6 - 13分）。当汇总这些研究的结果时，含鱼油的乳剂与死亡率降低趋势相关（风险比[RR]，0.71；95%置信区间[CI]，0.49 - 1.04；P = 0.08；异质性I² = 0%）以及机械通气时间缩短（天数的加权平均差[WMD]，-1.41；95% CI，-3.43至0.61；P = 0.17）。然而，该策略对感染（RR，0.76；95% CI，0.42 - 1.36；P = 0.35）和重症监护病房住院时间（WMD，-0.46；95% CI，-4.87至3.95；P = 0.84，异质性I² = 75%）没有影响。
含鱼油的脂质乳剂可能能够降低危重病患者的死亡率和通气天数。然而，由于临床数据匮乏，没有足够的证据推荐常规使用肠外鱼油。需要大型、设计严谨的RCT来阐明肠外鱼油在危重病患者中的疗效。
