| Objective:The intestine is the central organ of the body's stress response. Surgical trauma, stress caused by the release of inflammatory mediators, intestinal ischemia and reperfusion, the intestinal mucosal barrier dysfunction, intestinal bacteria and endotoxin translocation, further release of inflammatory mediators, and the role of the vital organs of the intestinal mucosa and systemic, resulting in systemic inflammatory response syndrome (SIRS), sepsis and multidysfunction ple organ syndrome (MODS) occurred. Therefore, the intestinal mucosal barrier function has become an important indicator to determine the prognosis. Fish oil fat emulsion injection (rich in omega-3multi unsaturated fatty acids), with significantly regulate the inflammatory mediators, reduce excessive stress response of the body and used in the SICU of critically ill patients to obtain a good effect. Fish oil fat emulsion can improve intestinal barrier function caused by the large and medium-sized surgical stress rarely reported. The purpose of this study is to observe the abdomen large and medium-sized post-operative changes of the intestinal mucosal barrier function and fish oil plus parenteral nutrition on intestinal mucosal barrier function and prognosis for early prevention and treatment of intestinal mucosal barrier dysfunction after abdominal surgery reference.Methods:Select44patients from the Second Affiliated Hospital surgical treatment of Kunming Medical College from January2011to December2011, who received elective abdominal surgery, of which18patients with liver resection,12patients with gastrointestinal surgery,14patients with colorectal,rectal surgery. Depending on the types of surgery patients were randomly divided into control group with22(7:9:6) patients and the fish oil group with22(5:9:8) patients. All the patients were abdominal surgery under general anesthesia.After operation the supplement of the two groups of patients by early enteral nutrition and parenteral nutrition increases by2-3d transition to full enteral nutrition, the units weight supplied equal heat and nitrogen. Take suction the two groups of patients'plasma when preoperative1d, postoperative1d and postoperative6d,measure the concentration of blood TNF-a> D-lactate; Recorded the complications and the length after operative.Results:1. TNF-a, D-lactic acid,IFABP,Positive rate of bacterial DNA in peripheral blood(l)TNF-a①Control group within the group:1d and3after surgery in patients with preoperative time points (postoperative12h,24h,72h) compared to the difference was statistically significant (P<0.01) difference was statistically compared with the postoperative144h significance (P<0.05). The control group of patients after12h of TNF-a significantly higher; postoperative24h of TNF-a to high value;72h after operation began to decline; postoperative144h has not yet returned to preoperative levels.②Within the group of fish oil group:patients with preoperative1d and postoperative12h,24h after surgery compared to the difference was statistically significant (P<0.01) and postoperative72h144h compared to postoperative difference was not statistically significant (P>0.05); fish oil group patients after12h of TNF-a significantly higher postoperative24h TNF-a high-value decreased significantly72h after operation, postoperative144h recovered to preoperative levels.③Between the two groups:one day the two groups of patients before surgery postoperative12h,24h after no statistically significant difference (P>0.05);72h compared to the difference of two groups of patients was statistically significant (P<0.01); patients in both groups144h compared the difference was statistically significant (P<0.05). The two groups of patients the postoperative12hTNF-a concentrations were significantly increased, and up to24h after the high-value, but the fish oil group a lesser extent; the postoperative72hTNF-a concentration began to decrease, but the fish oil group significantly decreased. Postoperative144h fish oil group have been restored to the preoperative level.(2) D-lactic acid②Control group of D-lactate group:1d and3after surgery in patients with preoperative time points (12h,24h,72h) compared to the difference was statistically significant (P<0.01). Compared with the postoperative144h difference was statistically significant (P<0.05). The control group patients12h D-lactate concentration was significantly increased24h after up to high-value,72h after operation began to decline significantly higher than preoperative levels after surgery144h.②The fish oil group of D-lactate group:day preoperative and postoperative2time points (after12h, postoperative24h) compared to the difference was statistically significant (P<0.01), compared to72h after operation the difference was statistically significant (P<0.05); compared with the postoperative144h was no significant difference (P>0.05); fish oil group patients12h D-lactate concentrations were significantly increased24h after up to high-value,72h after operation than before, significantly reduced postoperative144h slightly higher than the preoperative levels but the difference was not statistically significant.③D-lactic acid between the two groups:two groups of patients before surgery Id,12h,24h group difference was statistically significant (P>0.05); Patients in both groups72h,144h after surgery compared to the difference was statistically significant (P<0.05); two groups were compared the difference was statistically significant (P <0.01). Patients in both groups12h D-lactate concentrations were significantly increased, and up to24h after the high-value, but the fish oil group a lesser extent; the postoperative72hTNF-a concentration began to decrease, but the fish oil group significantly decreased. After144h fish oil group compared to the control group of D-lactate concentrations decreased significantly, and close to the preoperative level.(3) IFABP②Compared to the the IFABP group of the control group:preoperative and postoperative three points (after12h,24h,72h) and the difference was statistically significant (P<0.01); compared with the postoperative144h statistically significant (P<0.05). The control group patients after12h in IFABP concentration was significantly increased24h after up to high-value,72h after operation began to decline significantly higher than preoperative levels after surgery144h.②IFABP group of fish oil groups:patients with preoperative Id12h after surgery,24h after surgery compared difference was statistically significant (P<0.01), and72h after operation compared to the difference was statistically significant (P<0.05); compared with postoperative144h was no significant difference (P>0.05); fish oil group in patients with postoperative12h in IFABP concentration was significantly increased24h after up to high-value,72h after operation than before, significantly reduced postoperative144h slightly preoperative levels, but the difference was not statistically significant.③The in IFABP between the two groups:two groups of patients before surgery1d,12h,24h group difference was statistically significant (P>0.05); Patients in both groups72h,144h difference was statistically significant (P<0.05).Patients in both groups12h in IFABP concentration was significantly increased, and up to24h after the high-value, but the fish oil group a lesser extent; postoperative72h in IFABP concentration began to decrease, but the fish oil group significantly decreased. After144h fish oil group compared to control group IFABP concentration decreased significantly, and close to the preoperative level.(4) Positive rate of bacterial DNA in peripheral bloodPatients in both groups12h peripheral blood bacterial DNA in positive, up to24h after peripheral blood bacterial DNA positive rate began to decline72h after operation, postoperative144h still exist in peripheral blood bacterial DNA positive. The control group compared with the fish oil group, the fish oil group after72h,144h peripheral blood bacterial DNA positive rate was significantly decreased, acP<0.05, bdP<0.05. 2. Clinical parametersTwo groups of patients with postoperative infectious complication rate compared to the differences statistically significant (P<0.05); SIRS of two groups of patients had a higher incidence, but the fish oil group than the control group after72h, and144h of SIRS The incidence was significantly decreased (acP<0.05, bdP<0.05).3.Correlation AnalysisThe two groups of patients with D-lactate levels and IFABP level was highly correlated (P<0.01); two groups of TNF-a level of D-lactate levels in IFABP level was highly correlated (P<0.01). Patients in both groups of D-lactate level in IFABP levels of peripheral blood bacterial DNA positive rate the SIRS rates were highly correlated (P<0.01).Conclusions:1. Intestinal mucosal barrier dysfunction in patients after surgery of the abdomen large and medium-sized, and the higher the level of inflammation and intestinal barrier function damage, the more obvious the higher the incidence of bacterial translocation of SIRS higher the incidence may be related to inflammatory response causes intestinal ischemia and hypoxia increase, related to intestinal damage.2. Fish oil can reduce the levels of inflammatory mediators, reduce the inflammatory response and contribute to the recovery of the intestinal blood supply after surgery of the abdomen large and medium-sized and intestinal mucosal barrier function, reducing bacterial translocation, thereby reducing the occurrence of SIRS infection and other complications and improve clinical outcome. |
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