Effects Of Parenteral Nutrition Containing Fish Oil On Inflammatory Response,Nutritional State And Intestinal Barrier Of Patients With Gastrointestinal Malignancies After Operation

Gastrointestinal tumors are common in China. Most of the patients suffered advanced cancer when they were diagnosed, with poor prognosis.Preoperative tumor consumption, reduced food intake induced poor nutritional status. Surgical trauma and inflammatory response increase the incidence of postoperative complications and mortality of patients. When body suffered from burns,major surgery, trauma, or severe infections, stress responses lead to hypovolemia and circulating blood redistribution. Gastrointestinal blood flow reduction, the intestinal mucosal barrier damage, and even bacterial translocate result in intestinal-borne infections. Parenteral nutrition can prevent and reduce the deterioration of the nutritional status. Previous studies showed that the omega-3polyunsaturated fatty acids could reduce the excessive postoperative inflammation, improve the prognosis effectively. Animal experiments showed that the omega-3polyunsaturated fatty acid could protect structure and function of tight junction proteins. Studies found that the omega-3polyunsaturated fatty acids could improve the blood supply of body organs, and also could reduce the incidence of bacterial translocation.Lipofundin is widely used in clinical, in which the ratio of long chain fatty acids and middle chain fatty acids (MCT/LCT) is5:5. In Lipofundin, LCT and MCT are simply mixed. Lipoplus is a new fat emulsion. Compared to Lipofundin the difference is that Lipoplus replace part of the LCT with fish oil (FO).And in the Lipoplus the ratio of MCT, LCT and FO is5:4:1. Its effectiveness and safety research have been confirmed.Objective:To assess the effects of parenteral nutrition containing fish oil on inflammatory response,nutritional state and Intestinal barrier of Patients with Gastrointestinal Malignancies after Operation. Methods:In a prospective and double-blind study, sixty-four patients with gastrointestinal malignancies were randomized to receive isonitrogenous, isocaloric total parenteral nutrition over5days including either Lipoplus20%(32cases)or Lipofundin20%(32cases).All patients wrote informed consents. Exclusion criteria:(1)patients received chemotherapy or radiation therapy in30days before the start of the study;(2) patients received conventional parenteral nutrition therapy in7days before the start of the study;(3) patients had general contraindications for parenteral nutrition;(4) patients with severe organ dysfunction;(5)patients in pregnancy and/or lactation, patients were determined height (cm), weight(Kg)body mass index (BMI). Nutrition infusion:All patients will receive isonitrogenous, isoenergetic total parenteral nutrition. Total energy25kcal/kg/d, non-protein calorie20kcal/kg/d, ratio of Non-protein calorie and nitrogen100:1,nitrogen0.2g/kg/d. The dose of lipids and glucose could be reduced to50%on the first postoperative day. Electrolytes trace elements and vitamins can be administered once required. All patients will receive ALL IN ONE (TNA)nutrition injection containing fat emulsion,glucose and amino acid. Injection time last12-20h,nutrition treatment should continue up to d5postoperatively.Blood samples were gained before operation, the1st,2nd,3rd, and6th day after operation respectively to measure relative indexes about nutrition (prealbumin,retinol binding protein(RBP) and inflammatory response (C-reaction protein and leukotrieneLTB5, LTB4), samples were gained thelst,3rd, and5th day after operation respectively to measure the patient’s nitrogen balance and cumulative nitrogen-balance. Blood samples were gained before operation, the2h,1st,2nd,3rd, and6th day after operation respectively to measure I-FABP. Meanwhile, observe the incidence of postoperative SIRS,infection rate,incidence of postoperative complications, mortality, APACHEII score,length of stay and other clinical indicators.Results:inflammatory indexesC-reactive proteinCompared with the preoperative, CRP levels were significantly higher on dlpostoperatively in both groups(p<0.05). On d6postoperatively CRP level was significantly lower in Lipoplus group(p<0.05)but still higher than preoperative levels.LTB5/LTB4 Compared with postoperative dl,LTB5/LTB4significantly increased on d6postoperatively in Lipoplus group (p<0.05).Compared to postoperative d3, LTB5/LTB4had no significant changes on d6postoperatively (p>0.05). Compared with postoperative dl, d3,LTB5/LTB4did not significantly increase on d6postoperatively in Lipofundin group (p>0.05).There was no significant difference between two groups(p>0.05).Clinical indicatorsInfection rates were lower in Lipoplus group, but there were no significant differences in the two groups(p>0.05).Length of hospital stay was significantly lower in Lipoplus group mortality, there was no significant difference in APACHEII score in two groups(p>0.05).SIRS rate was significantly lower in Lipoplus(p<0.05).Nutrition indicatorsPrealbuminCompared with preoperative level, pre-albumin level was significantly lower on postoperative dl in both groups(p<0.05).On postoperative d3pre-albumin decreased to a minimum value, on postoperative d6it increased to the postoperative baseline level in both groups. Compared with preoperative d3,pre-albumin levels were significantly higher in both groups (P<0.0001), but no significant difference between the two groups(p>0.05).Retinol-binding proteinCompared with preoperative dl, RBP levels were significantly higher on preoperative d6in both groups (P<0.001). RBP levels was higher than preoperative level, but there was no significant difference between the two groups(p>0.05).Nitrogen balanceCompared with preoperative level, Nitrogen balance was significantly lower on postoperative dl in both groups(p<0.05). Compared with preoperative dl Nitrogen balance was significantly higher on preoperative d3,d6in both groups (p<0.05), but there was no significant difference between the two groups(p>0.05).Intestinal mucosal barrier indicatorSerum I-FABPCompared with preoperative level, Serum I-FABP was significantly higher on postoperative2h, d1in both groups(p<0.05). Serum I-FABP decreased significantly on postoperative d2in both groups(p<0.05). but there was no significant difference between the two groups(p>0.05).Conclusions:Parenteral nutrition containing fish oil can depress the excessively inflammatory reaction,improve the nutritional state of patients with gastrointestinal malignancies after operation,. Effect of Parenteral nutrition containing fish oil on the intestinal mucosal barrier of patients with gastrointestinal malignancies after operation is not obvious yet.