Federal University of Mato Grosso, Cuiabá, Brazil.
General University Hospital, Cuiabá, Brazil.
Nutr J. 2017 Apr 20;16(1):24. doi: 10.1186/s12937-017-0245-6.
A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays. The aim of this study was to assess morbidity (especially POAF) in ICU patients after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.
Fifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables and mortality were analyzed, examining the incidence of POAF, as well as the need for inotropic vasoactive drugs during surgery and in ICU.
Two deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Neither ICU stays nor total postoperative stays differed by group (P > 0.05). Patients given preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer instances of hospital infection (RR = 0.29, 95%CI 0.09-0.94; P = 0.023) and were less reliant on vasoactive amines during surgery (RR = 0.60, 95% CI 0.38-0.94; P = 0.020). Similarly, the number of patients requiring vasoactive drugs while recovering in ICU differed significantly by group (P = 0.008), showing benefits in patients given CHO loads. The overall incidence of POAF was 29.8% (17/57), differing significantly by group (P = 0.009). Groups given ω-3 PUFA (W3 and CHO + W3 groups) experienced significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56-15.02; P = 0.001).
Preoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG with CPB was observed.
NCT: 03017001.
在心血管手术中，很少有策略采用有限的术前禁食、碳水化合物（CHO）负荷和术中ω-3 多不饱和脂肪酸（ω-3 PUFA）输注。在麻醉前 2 小时进行短暂禁食并摄入 CHO，可能会改善 CABG 手术的恢复，并降低围手术期血管活性药物的需求。输注 ω-3 PUFA 可能会减少术后心房颤动（POAF）的发生并缩短住院时间。本研究的目的是评估在冠状动脉旁路移植术（CABG）/体外循环（CPB）联合进行时，如果术前禁食时间缩短有利于 CHO 负荷，并且术中输注 ω-3 PUFA，那么 ICU 患者的发病率（特别是 POAF）。
57 例行 CABG 的患者被随机分为接受 12.5%麦芽糖糊精（200ml，麻醉前 2 小时），不输注 ω-3 PUFA（CHO，n=14）；水（200ml，麻醉前 2 小时），不输注 ω-3 PUFA（对照组，n=14）；12.5%麦芽糖糊精（200ml，麻醉前 2 小时）加术中 ω-3 PUFA（0.2 mcg/kg）（CHO+W3，n=15）；或水（200ml，麻醉前 2 小时）加术中 ω-3 PUFA（0.2 mcg/kg）（W3，n=14）。分析围手术期临床变量和死亡率，检查 POAF 的发生率，以及手术和 ICU 期间对血管活性药物的需求。
发生 2 例死亡（3.5%），但无支气管吸入和纵隔炎发生。各组 ICU 住院时间和总术后住院时间无差异（P>0.05）。接受术前 CHO 负荷（CHO 和 CHO+W3 组）的患者发生医院感染的次数较少（RR=0.29，95%CI 0.09-0.94；P=0.023），并且在手术期间对血管活性胺的依赖性较低（RR=0.60，95%CI 0.38-0.94；P=0.020）。同样，在 ICU 恢复期间需要血管活性药物的患者数量也因组而异（P=0.008），接受 CHO 负荷的患者获益更多。POAF 的总发生率为 29.8%（17/57），各组间差异有统计学意义（P=0.009）。接受 ω-3 PUFA（W3 和 CHO+W3 组）的患者 POAF 发生率显著较低（RR=4.83，95%CI 1.56-15.02；P=0.001）。
在本队列中，术前禁食时间缩短是安全的。当与 CABG 手术期间的 CHO 负荷和 ω-3 PUFA 输注结合使用时，可加快 CPB 下 CABG 的恢复。
NCT: 03017001。
