| Background and Objectives: Trauma, referring to the injury of damage to structural integrity of body as a result that the energy of mechanical force is transmitted to human body, happens frequently both in peacetime and wartime. In recent years, with the improvement of system of remedy trauma and damage control strategy, antibiotics and supportive therapy have been widely used, the success rate of early treatment in trauma patients has greatly increased; however, the mortality and the incidence of complications do not reduce significantly. At present, much evidence show that the body's immune system would be in serious disorder post-traumatic. As a therapeutic fat emulsion agent, fish oil fat emulsion injection (be rich inω-3 polyunsaturated fatty acid) has been used to patients of sepsis, surgery, tumor, inflammatory bowel disease (IBD), organ fibrous degeneration, renal failure and paediatrics, etc. The safety and effectiveness of this injection have been proved, but its application research in terms of severe trauma is still very limited.In this study, we decided to observe the change of cellular immune function post-traumatic and the effects ofω-3 polyunsaturated fatty acid parenteral nutrition on these changes, so as to provide theoretical basis for the improvement of treatment of trauma patients and prognosis.Methods52 cases of trauma patients who had admission from Aug 2007 to March 2008, were divided into mild trauma group (n=24, ISS<16 or AIS=1~2), moderate trauma group (n=15, 16≤ISS<25 or AIS=3) and severe trauma group (n=13, ISS≥25 or AIS≥4) according to ISS (injury severity score) or AIS (abbreviated injury scale) score; And 26 patients with trauma (moderate trauma and severe trauma), who need parenteral nutrition, were randomly divided into the conventional group (n=13) and the fish oil group (n=13). 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. Another 20 health individuals served as control group. The treatment principle included active control of the original deal with trauma, early cardiopulmonary resuscitation, protection of organ function, correcting acid-base imbalance and water, and electrolyte disorders support.The periheral blood of trauma patients were collected at 1st, 3rd, 6th days at post traumatic. The concentration of serum CRP (C-reactive protein), MIF (migration inhibitory factor) and the concentration of plasma IFN-γ(interferon-γ) and IL-4 (interleukin-4) was measured with enzyme linked immunosorbent assay (ELISA). General clinical statistical information were record.Results1. There were no significant differences of age, admission time after injury and length of stay in hospital of different degree of trauma in three groups (P>0.05). Compared with the mild trauma group, the transfuion quantities at admission day intraoperative blood loss volume, intraoperative blood transfusion volume, operation persistent period and ICU treatment time decreased significantly in moderate trauma group and severe trauma groups (P<0.01). The rate of operation, intraoperative blood transfusion, the rate of ICU treatment, incidence of SIRS and incidence of infectious complications also decreased significantly(P<0.05 or P<0.01).2. Compared with the control group, the levels of CRP, MIF and IL-4 of different degrees of trauma in three groups patients increased significantly (P<0.01). The level of IFN-γlevel and the ratio of IFN-γ/IL-4 decreased significantly(P<0.01), and with the increasing of tramus degree, the difference became more significant.3. Compared with conventional group, there were no significant differences of the of levels of CRP and MIF in fish oil group (P>0.05) at 1st day. But at 3rd and 6th day post traumatic, the levels of CRP and MIF in fish oil group decreased significantly(P<0.05 or P<0.01).4. Compared with conventional group, there were no significant differences of the levels of IFN-γ, IL-4 and the ratio of IFN-γ/IL-4 in fish oil group (P>0.05). But the level of IFN-γand the ratio of IFN-γ/IL-4 in fish oil group increased significantly at 3rd and 6th day post traumatic, and the level of IL-4 decreased significantly(P<0.05 or P<0.01).5. Both conventional group and fish oil group had a high incidence of SIRS post-traumatic,and have no significant differences (P>0.05). But the incidence of SIRS in fish oil group decreased significantly contrast to conventional group at 3rd and 6th day post traumatic (P<0.01).Conclusions:1. The trauma patients have inflammatory reaction post traumatic, and the more serious the trauma degree is, the more obvious the inflammatory reaction will be.2. The cellular immune function of trauma patients is inhibited post traumatic, and the more serious the trauma degree is, the more obvious the inhibition of cellular immune function will be.3. Compared with conventional parenteral nutrition, the parenteral nutrition with the addition ofω-3PUFAs can significantly reduce the inflammatory response, promote the recovery of cellular immune function and reduce the occurrence of SIRS.
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