Safety And Efficacy Of A New Lipid Emulsion (SMOF) In Abdominal Surgical Patients Receiving Parenteral Nutrition:a Systematic Review And Meta-analysis

Fat emulsion injection for clinical has been close to 60 years.The Intralipid is the first and most widely used long-chain glycerol triacetate(LCT)fat emulsion with the drawback that it is slower in the blood,ω-6 Saturated fatty acid content is relatively high,and relatively high reesterification of triglycerides in most tissue storage,and may affect the body’s immune system,but has not been confirmed in the practice of clinical application.Due to surgical trauma,ischemia-reperfusion injury,and infection and many other unfavorable factors,postoperative critically ill patients are likely to cause the body environment disorders,immunosuppression,severe systemic inflammatory response and high metabolic status,postoperative how to choose a reasonable parenteral nutrition(PN)to support treatment is important.At present,fat emulsion commonly used in clinical are mostly rich in omega-6 fatty acids,may increase the body’s inflammatory response,adverse effects on the prognosis.With the deepening of nutrition research,scientists have developed a mixture of medium chain triglycerides(MCT)and LCT,as well as later structured triglyceride fat emulsions,which is composed of two carbon atoms in the chain of fatty acids.A number of studies have shown that the level of metabolism of it is higher than Italipid,and the oxidation is more rapid and is rarely stored in human tissues because its oxidation does not depend on carnitine and therefore has little effect on the human body’s endothelial system.At the beginning of this century,the physical mixing of MCT/LCT developed rapidly and widely used in clinical;structural fat emulsion in the early 90 s has also been applied to clinical,its safety and effectiveness has been affirmed.The clinical significance of providing fat emulsions through parenteral nutrition is to provide energy for the body,to provide essential fatty acids and trace elements.A number of studies have shown that omega-6 and omega-3 fatty acids can effectively regulate the inflammatory response of the human body system,which led researchers to continue to study and develop another new fish fat emulsion: omega-3 fatty acids rich in eicosapentaene acid(EPA)and docosahexaenoic acid(DHA)fat emulsions,which are the beginning of the new fat emulsion SMOF study.Objective: To compare the effects of a new fat emulsion SMOF(soybean oil,MCT/LCT,olive oil)on inflammatory changes,immune function,adverse complications and prognosis with common parenteral fat emulsion in patients with postoperative abdominal surgery,we analyze them with meta-analysis.Methods: A new type of mixed fat emulsion containing soybean oil,MCT,fish oil,olive oil,Vit E(ie,SMOF).Compared with soybean oil,MCT/LCT,fish oil,olive oil,was used to investigate the inflammatory response,immune function,complication.Prognosis and other relations of postoperative patients with gastrointestinal surgery.And the relevant RCTs are searched,we summarize and analyze the data from the original experiment,and use the software tool Review manager(version 5.3)to provide a meta-analysis of the data we obtained.Result: A total of 12 RCTs were included in the study.The patients in the case group were selected with SMOF parenteral nutrition solution,and the control group was selected with nonSMOF(soybean oil,MCT/LCT,olive oil)conventional general parenteral nutrition solution.The levels of liver function index AST,ALT,GGT,ALP;inflammatory factors CRP,IL-6,TNF-α,and nutritional indicators AA,EPA,DHA,and the number of days of hospitalization were compared between the two groups and meta-analysis was performed.The results showed that the incidence of postoperative complications was lower in patients with SMOF mixed fat energy regimen than in the group of common mixed fat energy.The indexes of AST,ALT,GGT,ALP and nutritional indicators of AA,EPA and DHA were statistically significant.Conclution: Different from the traditional common fat emulsion,the new mixed fat emulsion nutrition agent(SMOF)can control the more serious complications after surgery,reduce the mortality,significantly inhibit the adverse reactions of inflammation,significantly shorten the time of the patient in intensive care or special management,thus better to ensure the normal function of the human vital organs(such as the liver),to improve the nutritional status of patients.