Changes Of Intestinal Barrier Function Of Traumatic Patients And Effect Of Parenteral Nutrition With Fish Oil To It

ObjectiveSevere traumatic patients always had a severe blood loss, for maintaining blood supply of heart and head, the gut would appear ischemic and anoxemia through the mechanisms of intestinal ischemic, reperfusion and release of mediators of inflammation and so on, which could cause functional impairment of intestinal barrier and translocation of intestinal bacterium and endotoxin, accordingly, induce the occur of SIRS (systemic inflammatory response syndrome), sepsis and MODS (multiple organ dysfunction syndrome). Therefore, intestinal barrier function had become an important index to judge prognosis of severe cases. As a therapeutic fat emulsion, fish oil parenteral solution, which is abundant withω-3 polyunsaturated fatty acid, had made some exploratory development on sepsis, surgery, tumor, IBD (inflammatory bowel disease), organ fibrous degeneration, renal failure and paediatrics and so on, its safety and validity had been confirmed, but exploratory development on severe trauma was blank. So the aim of this study was to investigate the changes of intestinal barrier function of different severity traumatic patients and the influence of parenteral nutrition with fish oil to it and prognosis, thus to provide new clinical strategies for prevention and effective remedy of intestinal barrier functional impairment.Methods52 cases of trauma patients, who were admitted between August 2007 and March 2008, were divided into mild injury group(n=24,ISS<16 or AIS=1～2),moderate injury group(n=15,16≤ISS<25 or AIS=3) and severe injury group(n=13,ISS≥25 or AIS≥4) according to ISS (injury severity score) or AIS (abbreviated injury scale); then 26 traumatic patients(ISS≥16 or AIS≥4) were divided into the conventional group(n=13) and the fish oil group(n=13) randomly according to whether parenteral nutrition with fish oil. Both groups were administrated with an isonitrogenous and isocaloric parenteral nutrition. Conventional group was given parenteral with soybean oil 1.2g·kg-1·d-1, fish oil group with soybean oil 1.0g·kg-1·d-1 and fish oil 0.2g·kg-1·d-1 for 5 days. 10 healthy persons were served as the control group. Peripheral venous blood was collected from control group for once,and from other groups on 1st,3rd and 6th day respectively after trauma.The concentration of plasma D-lactate was measured with spectrophotometric assay and the concentration of serum IFABP was measured with enzyme linked immunosorbent assay (ELISA). Record the volume of blood transfusion and transfusion, SIRS, infection complication and the length of hospital stay.Results1. Compared with the control group, the level of D-lactate and IFABP in mild injury group were not marked changed (P>0.05) after trauma, but they had a obvious increase (P<0.01) on 1st day after trauma in the moderate and severe group, and the severe group was higher than the moderate group, then descend gradually, on 6th day after trauma, the moderate group was close to the normal level, but the severe group was also higher than the normal remarkably (P<0.01);2. D-lactate and IFABP had a significant correlation (respectively on D1 , D3 and D6, r was 0.949, 0.871 and 0.951, P<0.01). The levels of D-lactate(respectively on D1 , D3 and D6, r was 0.507, 0.468 and 0.312, P<0.01) and IFABP(respectively on D1 , D3 and D6, r was 0.562, 0.534 and 0.465, P<0.01) had a positive correlation with the volume transfused, and the rate of SIRS had a positive correlation with the level of IFABP(respectively on D1 , D3 and D6, r was 0.542, 0.566 and 0.469, P<0.01) and D-lactate (respectively on D1 , D3 and D6 day, r was 0.488, 0.606 and 0.421, P<0.01).3. The level of serum IFABP and plasma D-lactate were increased obviously after injury, and then descended gradually, but the fish oil group descended more significantly than conventional group. Compared with conventional group, the rates of SIRS and infection complication of fish oil group were lower; the length of hospital stay was shorter.Conclusions1. the more severe multiple injury patients were, the more significant the impairment of intestinal barrier function was, which may be related to impairment of intestinal mucosal hypo perfusion induced by blood loss, and the rate of SIRS was higher, the length of hospital stay was longer.2. Fish oil was benefit for intestinal blood supply and recovery of intestinal barrier function after severe injury, and ameliorated patients'prognosis, may reduce the incidence of SIRS or infection, shorten the length of hospital stay.