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肠外补充二十碳五烯酸/二十二碳六烯酸ω-3脂肪酸可改善危重症患者的康复预后

[Parenteral supplementation with EPA/DHA omega-3 fatty acids improves recovery prognosis in critically ill patients].

作者信息

Lira Marcial Ethel, García-Montalvo Iván Antonio, Contreras Oliveros María de Los Ángeles, Macías Moreno Michelle

机构信息

Servicio de Nutrición Clínica Parenteral. Hospital General de Puebla "Dr. Eduardo Vázquez Navarro". Facultad de Medicina, Licenciatura en Nutrición Clínica. Benemérita Universidad Autónoma de Puebla.

División de Estudios de Posgrado e Investigación.Tecnológico Nacional de México/Instituto Tecnológico de Oaxaca.

出版信息

Nutr Hosp. 2023 Feb 15;40(1):3-12. doi: 10.20960/nh.04227.

Abstract

Introduction: the decision to supplement total parenteral nutrition (TPN) with emulsions of omega-3 (Ω3) eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids (FA) of marine origin is based on the clinical benefits obtained in different medical situations and surgical procedures, among which reductions in hospital stay, days of mechanical ventilation, incidence of infections and mortality stand out. However, the evidence in critically ill patients remains contradictory. Objective: the objective of this clinical trial was to analyze the effect of supplementation with EPA/DHA Ω3 FAs on clinical prognostic markers - medical, nutritional and biochemical - in critically ill patients, relating to outcome. Method: a clinical, controlled, randomized, single-center trial in 64 critically ill adult patients, of which 47 patients were randomized to receive TPN supplemented with EPA/DHA Ω3 FAs in doses of 0.1 g/kg/day (n = 23) and 0.2 g/kg/day (n = 24), compared with a historical control group with TPN without supplementation (n = 17). Clinical prognosis markers were determined at baseline and at the end of nutritional support (medical, nutritional and biochemical). Results: the two groups with supplementation showed a statistically significant reduction in mortality (p < 0.005); the clinical prognostic markers SOFA, APACHE II, SAPS 3, NUTRIC, RTL and CRS were consistent in showing a significant improvement (p < 0.005), of prognosis with doses of 0.1 and 0.2 g/kg/day of EPA/DHA Ω3 FAs, respectively. Conclusion: supplementation of parenteral nutrition with EPA/DHA Ω3 fatty acids at doses of 0.1 g and 0.2 g/kg/day improves recovery prognosis and the probability of survival in critically ill patients.

摘要

引言

决定在全胃肠外营养(TPN)中添加海洋来源的ω-3(Ω3)二十碳五烯酸(EPA)和二十二碳六烯酸(DHA)脂肪酸(FA)乳剂,是基于在不同医疗情况和外科手术中获得的临床益处,其中住院时间缩短、机械通气天数减少、感染发生率降低和死亡率降低尤为突出。然而,危重症患者的相关证据仍存在矛盾。目的:本临床试验的目的是分析补充EPA/DHA Ω3脂肪酸对危重症患者临床预后标志物(医学、营养和生化方面)与预后的影响。方法:对64例成年危重症患者进行一项临床、对照、随机、单中心试验,其中47例患者随机接受补充剂量为0.1 g/kg/天(n = 23)和0.2 g/kg/天(n = 24)的EPA/DHA Ω3脂肪酸的TPN,与未补充的TPN历史对照组(n = 17)进行比较。在基线和营养支持结束时(医学、营养和生化方面)确定临床预后标志物。结果:两组补充组的死亡率均有统计学显著降低(p < 0.005);临床预后标志物序贯器官衰竭评估(SOFA)、急性生理与慢性健康状况评分系统II(APACHE II)、简化急性生理学评分系统3(SAPS 3)、营养风险及预后营养指数(NUTRIC)、反应性体温升高(RTL)和临床恢复评分(CRS)一致显示,分别使用0.1和0.2 g/kg/天的EPA/DHA Ω3脂肪酸剂量时,预后有显著改善(p < 0.005)。结论:每天以0.1 g和0.2 g/kg的剂量补充EPA/DHA Ω3脂肪酸进行肠外营养,可改善危重症患者的恢复预后和生存概率。

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