Institute of Hepato-Pancreato-Biliary Surgery center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Eur J Clin Nutr. 2018 Aug;72(8):1159-1166. doi: 10.1038/s41430-018-0256-1. Epub 2018 Jul 13.
It is reported that lipid emulsion enriched in n-3 fatty acids (FAs) helps us to improve postoperative recovery for surgical patients with biliary tract disease. Its role for postoperative patients with obstructive jaundice is as yet unclear. The object of this study was to evaluate the safety and efficacy of n-3 fatty acid-based parenteral nutrition (PN) for patients with obstructive jaundice following surgical procedures.
Data were collected from patients with obstructive jaundice who received PN, including n-3 PUFA-enriched lipid emulsions and standard non-enriched lipid emulsions (e.g., soybean oil). We then calculated a propensity score, the probability of receiving different PN, by the propensity score matched (PSM) method. After matching, we compared isonitrogenous total PN with 20% Structolipid and 10% n-3 fatty acid (Omegaven, Fresenius-Kabi, Germany) (treatment group) to Structolipid alone (control group) for 5 days postoperatively, in the absence of enteral nutrition.
Before the propensity score matching, there were 226 patients enrolled. After propensity score stratification, 108 cases remained, and all covariates were balanced. Among matched patients with PN, patients in the control group were at a higher risk for long-term jaundice recovery (12.9 ± 8.5 VS 16.4 ± 7.9 P = 0.029), lower velocity of reduction in jaundice (P = 0.045), and lower pre-albumin (P = 0.002). No significant difference as found in terms of comorbidities, white blood cell (WBC), albumin and other aspects.
PN with n-3 PUFA-enriched lipid emulsions was safe and effective in accelerating jaundice recovery for patients after surgical procedures. This trial was registered at clinicaltrials.gov as NCT03376945.
据报道，富含 n-3 脂肪酸（FAs）的脂质乳剂有助于改善胆道疾病手术患者的术后恢复。其在梗阻性黄疸术后患者中的作用尚不清楚。本研究旨在评估富含 n-3 脂肪酸的肠外营养（PN）在外科手术后梗阻性黄疸患者中的安全性和有效性。
收集接受 PN 的梗阻性黄疸患者的数据，包括富含 n-3 多不饱和脂肪酸的脂质乳剂和标准非富含脂质乳剂（如大豆油）。然后，我们通过倾向评分匹配（PSM）方法计算接受不同 PN 的可能性，即倾向评分。匹配后，我们比较了术后 5 天内无肠内营养的等氮总 PN 与 20% Structolipid 和 10% n-3 脂肪酸（德国 Fresenius-Kabi 的 Omegaven）（治疗组）和单独使用 Structolipid（对照组）。
在进行倾向评分匹配之前，共纳入 226 例患者。经过倾向评分分层后，仍有 108 例患者，所有协变量均达到平衡。在接受 PN 的匹配患者中，对照组患者的长期黄疸恢复风险更高（12.9±8.5 VS 16.4±7.9，P=0.029），黄疸消退速度较慢（P=0.045），前白蛋白水平较低（P=0.002）。但在合并症、白细胞（WBC）、白蛋白等方面无显著差异。
富含 n-3 多不饱和脂肪酸的 PN 可安全有效地加速手术患者的黄疸消退。该试验在 clinicaltrials.gov 注册，编号为 NCT03376945。
