Department of Anesthesiology and Reanimation, Faculty of Medicine and Health Sciences, Sherbrooke University Hospital, Sherbrooke, Québec, Canada.
Ipanema Research Trust, Auckland, New Zealand.
Clin Nutr. 2017 Jun;36(3):737-746. doi: 10.1016/j.clnu.2016.05.013. Epub 2016 May 27.
Omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation is an attractive therapeutic option for patients undergoing open-heart surgery due to their anti-inflammatory and anti-arrhythmic properties. Several randomized controlled trials (RCT) have found contradictory results for perioperative ω-3 PUFA administration. Therefore, we conducted an updated systematic review and meta-analysis evaluating the effects of perioperative ω-3 PUFA on some clinically important outcomes for cardiac surgery.
A systematic literature search was conducted to find RCT evaluating clinical outcomes after ω-3 PUFA therapy in adult patients undergoing cardiac surgery. Intensive care unit (ICU) length of stay (LOS) was the primary outcome; secondary outcomes were hospital LOS, postoperative atrial fibrillation (POAF), mortality and duration of mechanical ventilation (MV). Predefined subgroup analysis and sensibility analysis were performed.
A total of 19 RCT including 4335 patients met inclusion criteria. No effect of ω-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95% confidence interval, CI -10.28 to 4.39, P = 0.43). However, ω-3 PUFA reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No effects were found on mortality or MV duration. Heterogeneity remained in subgroup analysis and we found a significant POAF reduction when ω-3 PUFA doses were administered to patients exposed to extra-corporeal circulation. Oral/enteral administration seemed to further reduce POAF.
In patients undergoing cardiac surgery, ω-3 PUFA supplementation by oral/enteral and parenteral route reduces hospital LOS and POAF. Nonetheless considerable clinical and statistical heterogeneity weaken our findings.
由于具有抗炎和抗心律失常的特性，ω-3 多不饱和脂肪酸（ω-3PUFA）补充剂是一种有吸引力的治疗选择，适用于接受心脏直视手术的患者。几项随机对照试验（RCT）对围手术期ω-3PUFA 给药的结果得出了相互矛盾的结论。因此，我们进行了一项更新的系统评价和荟萃分析，评估围手术期ω-3PUFA 对心脏手术一些临床重要结局的影响。
系统地检索了评估ω-3PUFA 治疗成人心脏手术后临床结局的 RCT 文献。重症监护病房（ICU）住院时间（LOS）是主要结局；次要结局为住院 LOS、术后心房颤动（POAF）、死亡率和机械通气（MV）持续时间。进行了预设的亚组分析和敏感性分析。
共有 19 项 RCT 纳入 4335 名患者符合纳入标准。ω-3PUFA 对 ICU LOS 没有影响（加权均数差 WMD-2.95，95%置信区间，CI-10.28 至 4.39，P=0.43）。然而，ω-3PUFA 减少了住院 LOS（WMD-1.37，95%CI-2.41 至-0.33；P=0.010）和 POAF 发生率（优势比 OR=0.78，95%CI0.68 至 0.90；P=0.004）。死亡率或 MV 持续时间无影响。亚组分析中存在异质性，当 ω-3PUFA 剂量给予暴露于体外循环的患者时，我们发现 POAF 显著减少。口服/肠内给药似乎进一步降低了 POAF 的发生率。
在接受心脏手术的患者中，口服/肠内和肠外途径补充 ω-3PUFA 可减少住院 LOS 和 POAF。然而，相当大的临床和统计异质性削弱了我们的发现。
