Prophylactic effect of ω-3 polyunsaturated fatty acids on delirium in elderly patients aftergastric cancer surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIANG Tao ,  WU Xiaoting

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WU Xiaoting, Email: wxt1@medmail.com.cn

Keywords：

ω-3 polyunsaturated fatty acids; postoperative delirium; gastric cancer; elderly patient; perspective study

DOI：

10.7507/1007-9424.201808042

Video：

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Objective To investigate the effect of omega-3 polyunsaturated fatty acids on delirium in elderly patients after taking gastric cancer surgery.Methods A prospective study was conducted. Elderly patients with gastric cancer undergoing radical gastrectomy in West China Hospital of Sichuan University from June 2015 to June 2018 were divided into experimental group and control group for the purpose of research. All patients were operated by the same group of surgeons and anesthesiologists. Patients in the experimental group received intravenous infusion of 10% fish fat emulsion (Ewing) 100 mL daily from the first day after operation extra to routine treatment; patients in the control group received routine treatment after operation. The postoperative delirium, inflammation, complications, hospital stay, andre-admission on 30 days were compared between the two groups.Results A total of 205 patients were under research. The results were as follows. ① There were 47 delirium patients in the control group and 22 delirium patients in the experimental group. The difference between the two groups was statistically significant (P<0.001). There were 32 cases and 19 cases discovered with delirium in the control group and the experimental group during 1-3 days after operation; there were 19 cases and 6 cases were detected with delirium in the control group and the experimental group during 4-7 days after operation, respectively. The difference was considered statistically significant (P<0.05). ② Inflammation indexes of the experimental group were significantly lower than those of the control group on the 3^rd and 7^th day after operation, including count of WBC, C-reactive protein, interleukin-6, tumor necrosis factor-α, and platelet crit, and the difference were statistically significant (P<0.05). ③ Postoperative fever occurred in 46 patients in the experimental group, while 71 patients in the control group. The difference was statistically significant (P<0.01). ④ There were 2 cases of incision liquefaction in the control group and 1 case of mild chylous leakage in the experimental group. There was no significant difference in incision liquefaction rate and chylous leakage rate between the two groups (P>0.05). ⑤ The average hospitalization time of the experimental group was shorter than that of the control group ［(8±1) d vs. (9±2) d］. The difference was considered statistically significant (P<0.01).Conclusion ω-3 polyunsaturated fatty acids can reduce postoperative delirium and improve short-term prognosis in elderly patients with gastric cancer by controlling inflammation and stress response.

Citation： LIANG Tao, WU Xiaoting. Prophylactic effect of ω-3 polyunsaturated fatty acids on delirium in elderly patients aftergastric cancer surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(2): 174-179. doi: 10.7507/1007-9424.201808042 Copy

1.	Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920): 911-922.
2.	Brouquet A, Cudennec T, Benoist S, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg, 2010, 251(4): 759-765.
3.	Olin K, Eriksdotter-J?nhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg, 2005, 92(12): 1559-1564.
4.	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
5.	Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry, 2013, 21(12): 1190-1222.
6.	王瑾, 于健春, 康維明, 等. 魚油脂肪乳劑對炎癥的影響及其臨床應用. 中國實用外科雜志, 2011, 31(4): 354-357.
7.	趙明利, 于健春, 康維明. 脂肪乳劑的研究進展. 中國臨床營養雜志, 2008, 16(3): 184-191.
8.	黎介壽. 臨床營養支持的發展趨勢. 腸外與腸內營養, 2010, 17(1): 1-4.
9.	王新穎, 黎介壽. ω-3 多不飽和脂肪酸影響炎癥和免疫功能的基礎研究. 腸外與腸內營養, 2007, 14(1): 54-58.
10.	Heude B, Ducimetière P, Berr C, et al. Cognitive decline and fatty acid composition of erythrocyte membranes—the EVA Study. Am J Clin Nutr, 2003, 77(4): 803-808.
11.	Tan ZS, Harris WS, Beiser AS, et al. Red blood cell ω-3 fatty acid levels and markers of accelerated brain aging. Neurology, 2012, 78(9): 658-664.
12.	Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract, 2009, 24(4): 487-499.
13.	Han YY, Lai SL, Ko WJ, et al. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract, 2012, 27(1): 91-98.
14.	Ortiz Leyba C, Montejo González JC, Vaquerizo Alonso C, et al. Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente sépticoGuidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): patient with sepsis. Med Intensiva, 2011, 35(Suppl 1): 72-76.
15.	Cotogni P, Muzio G, Trombetta A, et al. Impact of the omega-3 to omega-6 polyunsaturated fatty acid ratio on cytokine release in human alveolar cells. JPEN J Parenter Enteral Nutr, 2011, 35(1): 114-121.
16.	Hagi A, Nakayama M, Shinzaki W, et al. Effects of the omega-6: omega-3 fatty acid ratio of fat emulsions on the fatty acid composition in cell membranes and the anti-inflammatory action. JPEN J Parenter Enteral Nutr, 2010, 34(3): 263-270.
17.	Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition, 2012, 28(6): 623-629.
18.	Hao W, Wong OY, Liu X, et al. ω-3 fatty acids suppress inflammatory cytokine production by macrophages and hepatocytes. J Pediatr Surg, 2010, 45(12): 2412-2418.
19.	Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr, 2005, 24(1): 55-65.
20.	Heller AR, R?ssel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer, 2004, 111(4): 611-616.
21.	Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
22.	Gianotti L, Braga M, Nespoli L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology, 2002, 122(7): 1763-1770.
23.	Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res, 2003, 36(4): 433-446.
24.	Rao GH, Radha E, White JG. Effect of docosahexaenoic acid (DHA) on arachidonic acid metabolism and platelet function. Biochem Biophys Res Commun, 1983, 117(2): 549-555.
25.	Pottala JV, Yaffe K, Robinson JG, et al. Higher RBC EPA+DHA corresponds with larger total brain and hippocampal volumes: WHIMS-MRI study. Neurology, 2014, 82(5): 435-442.
26.	Dangour AD, Allen E, Elbourne D, et al. Effect of 2-y n-3 long-chain polyunsaturated fatty acid supplementation on cognitive function in older people: a randomized, double-blind, controlled trial. Am J Clin Nutr, 2010, 91(6): 1725-1732.
27.	Van de Rest O, Geleijnse JM, Kok FJ, et al. Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology, 2008, 71(6): 430-438.
28.	Yurko-Mauro K, McCarthy D, Rom D, et al. Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline. Alzheimers Dement, 2010, 6(6): 456-464.
29.	Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
30.	Cooper RE, Tye C, Kuntsi J, et al. Omega-3 polyunsaturated fatty acid supplementation and cognition: a systematic review and meta-analysis. J Psychopharmacol, 2015, 29(7): 753-763.

1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920): 911-922.
2. Brouquet A, Cudennec T, Benoist S, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg, 2010, 251(4): 759-765.
3. Olin K, Eriksdotter-J?nhagen M, Jansson A, et al. Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg, 2005, 92(12): 1559-1564.
4. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
5. Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry, 2013, 21(12): 1190-1222.
6. 王瑾, 于健春, 康維明, 等. 魚油脂肪乳劑對炎癥的影響及其臨床應用. 中國實用外科雜志, 2011, 31(4): 354-357.
7. 趙明利, 于健春, 康維明. 脂肪乳劑的研究進展. 中國臨床營養雜志, 2008, 16(3): 184-191.
8. 黎介壽. 臨床營養支持的發展趨勢. 腸外與腸內營養, 2010, 17(1): 1-4.
9. 王新穎, 黎介壽. ω-3 多不飽和脂肪酸影響炎癥和免疫功能的基礎研究. 腸外與腸內營養, 2007, 14(1): 54-58.
10. Heude B, Ducimetière P, Berr C, et al. Cognitive decline and fatty acid composition of erythrocyte membranes—the EVA Study. Am J Clin Nutr, 2003, 77(4): 803-808.
11. Tan ZS, Harris WS, Beiser AS, et al. Red blood cell ω-3 fatty acid levels and markers of accelerated brain aging. Neurology, 2012, 78(9): 658-664.
12. Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract, 2009, 24(4): 487-499.
13. Han YY, Lai SL, Ko WJ, et al. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract, 2012, 27(1): 91-98.
14. Ortiz Leyba C, Montejo González JC, Vaquerizo Alonso C, et al. Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente sépticoGuidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): patient with sepsis. Med Intensiva, 2011, 35(Suppl 1): 72-76.
15. Cotogni P, Muzio G, Trombetta A, et al. Impact of the omega-3 to omega-6 polyunsaturated fatty acid ratio on cytokine release in human alveolar cells. JPEN J Parenter Enteral Nutr, 2011, 35(1): 114-121.
16. Hagi A, Nakayama M, Shinzaki W, et al. Effects of the omega-6: omega-3 fatty acid ratio of fat emulsions on the fatty acid composition in cell membranes and the anti-inflammatory action. JPEN J Parenter Enteral Nutr, 2010, 34(3): 263-270.
17. Wang J, Yu JC, Kang WM, et al. Superiority of a fish oil-enriched emulsion to medium-chain triacylglycerols/long-chain triacylglycerols in gastrointestinal surgery patients: a randomized clinical trial. Nutrition, 2012, 28(6): 623-629.
18. Hao W, Wong OY, Liu X, et al. ω-3 fatty acids suppress inflammatory cytokine production by macrophages and hepatocytes. J Pediatr Surg, 2010, 45(12): 2412-2418.
19. Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr, 2005, 24(1): 55-65.
20. Heller AR, R?ssel T, Gottschlich B, et al. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer, 2004, 111(4): 611-616.
21. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 2004, 291(14): 1753-1762.
22. Gianotti L, Braga M, Nespoli L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology, 2002, 122(7): 1763-1770.
23. Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz J Med Biol Res, 2003, 36(4): 433-446.
24. Rao GH, Radha E, White JG. Effect of docosahexaenoic acid (DHA) on arachidonic acid metabolism and platelet function. Biochem Biophys Res Commun, 1983, 117(2): 549-555.
25. Pottala JV, Yaffe K, Robinson JG, et al. Higher RBC EPA+DHA corresponds with larger total brain and hippocampal volumes: WHIMS-MRI study. Neurology, 2014, 82(5): 435-442.
26. Dangour AD, Allen E, Elbourne D, et al. Effect of 2-y n-3 long-chain polyunsaturated fatty acid supplementation on cognitive function in older people: a randomized, double-blind, controlled trial. Am J Clin Nutr, 2010, 91(6): 1725-1732.
27. Van de Rest O, Geleijnse JM, Kok FJ, et al. Effect of fish oil on cognitive performance in older subjects: a randomized, controlled trial. Neurology, 2008, 71(6): 430-438.
28. Yurko-Mauro K, McCarthy D, Rom D, et al. Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline. Alzheimers Dement, 2010, 6(6): 456-464.
29. Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
30. Cooper RE, Tye C, Kuntsi J, et al. Omega-3 polyunsaturated fatty acid supplementation and cognition: a systematic review and meta-analysis. J Psychopharmacol, 2015, 29(7): 753-763.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prophylactic effect of ω-3 polyunsaturated fatty acids on delirium in elderly patients aftergastric cancer surgery

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