OBJECTIVE:To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). METHODS:57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. RESULTS:There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). CONCLUSION:Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

译文

目的:评估术前禁食与碳水化合物(CHO)负荷和术中输注omega-3多不饱和脂肪酸(ω-3PUFA)的关联,以评估术后临床数据。
方法:57例接受冠状动脉搭桥术(CABG)的患者被随机分配接受12.5%的麦芽糊精(麻醉前2 h,200 mL),(CHO,n = 14);水(200 mL,麻醉前2 h)(对照,n = 14); 12.5%麦芽糊精(200 mL,麻醉前2小时)加上术中ω-3PUFA输注(0.2 g / kg),(CHO W3,n = 15);或用水(麻醉前2 h,200 mL)加术中输注ω-3PUFA(0.2 g / kg),(W3,n = 14)。除了术后炎症和代谢控制外,还分析了对血管活性药物的需求。
结果:有两人死亡(3.5%)。 CHO组患者的医院感染发生率较低(RR = 0.29,95%CI 0.09-0.94; P = 0.023),在手术和ICU停留期间需要较少的血管活性药物(P <0.05);并且在恢复的前六个小时血糖水平更高(P = 0.015),所需的外源胰岛素较少(P = 0.018)。各组术后房颤的发生率差异显着(P = 0.009)。接受ω-3PUFA组的受试者发生POAF的次数较少(RR = 4.83,95%CI 1.56-15.02; P = 0.001)。 W3组患者术后36 h的超敏CRP水平较低(P = 0.008)。白细胞介素10水平在各组之间不同(P = 0.013),在术中输注ω-3PUFA的患者术后观察到最高水平(P = 0.049)。
结论:快速补充碳水化合物负荷量和术中输注ω-3PUFA是安全的,并支持接受泵上CABG的患者术后恢复更快。

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