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目的探讨多发伤后细胞免疫功能的变化及加鱼油肠外营养对多发伤患者的影响。方法2007年8月至2008年3月本中心收治的26例多发伤患者随机分为鱼油组和常规组,入院后即按等氮等热量的肠外营养方式给药:常规组脂肪采用大豆油1.2 g.kg-1.d-1,鱼油组脂肪采用大豆油1.0 g.kg-1.d-1加鱼油0.2 g.kg-1.d-1,均连续使用5 d。于入院后及治疗后第3、6天采集患者外周静脉血,ELISA法检测CRP、MIF、IFN-γ及IL-4浓度。结果多发伤患者外周血中CRP、MIF、IL-4水平均较对照组升高非常显著(P<0.01),IFN-γ水平较对照组降低非常显著(P<0.01);治疗后第3天,鱼油组CRP、IL-4水平较常规组显著降低(P<0.05),MIF水平较常规组降低非常显著(P<0.01),IFN-γ水平较常规组显著升高(P<0.05);治疗后第6天,鱼油组CRP、IL-4水平均较常规组降低非常显著(P<0.01),IFN-γ水平较常规组升高非常显著(P<0.01)。结论常规治疗的同时,补充ω-3 PUFAs可以显著改善多发伤患者机体免疫防御,有效抑制了Th1/Th2应答模式的偏移,降低了多发伤后过度的炎症反应程度,对提高多发伤患者的救治具有重要意义。
Objective To investigate the changes of cellular immune function after multiple traumatic injury and the effects of adding parenteral nutrition on multiple trauma patients. Methods From August 2007 to March 2008, 26 patients with multiple traumatic injuries admitted to our hospital were randomly divided into fish oil group and conventional group. After admission, they were given parenteral nutrition such as isothermal nitrogen. The conventional group received soybean oil 1.2 g.kg-1.d-1, the fish oil group adopted soybean oil 1.0 g.kg-1.d-1 plus fish oil 0.2 g.kg-1.d-1 for 5 days. Peripheral venous blood was collected after admission and on the 3rd and 6th day after treatment, and the levels of CRP, MIF, IFN-γ and IL-4 were detected by ELISA. Results The levels of CRP, MIF and IL-4 in the peripheral blood of patients with multiple traumatic injuries were significantly higher than those in the control group (P <0.01), while the levels of IFN-γ were significantly lower than those in the control group (P <0.01) (P <0.05). The levels of CRP and IL-4 in fish oil group were significantly lower than those in normal group (P <0.05). The levels of MIF were significantly lower than those in normal group (P <0.01) On the 6th day after treatment, CRP and IL-4 levels in fish oil group were significantly lower than those in normal group (P <0.01), and IFN-γ levels were significantly higher than those in normal group (P <0.01). CONCLUSIONS: Conventional treatment with supplementation of ω-3 PUFAs can significantly improve the body’s immune defense in patients with multiple trauma and effectively suppress the shift of the Th1 / Th2 response pattern and reduce the excessive inflammatory reaction after multiple trauma. Treatment is of great significance.