Oleh Admin Kalbe Medical pada February 10, 2017 07:30

Manfaat PUFA Omega-3 pada Luka Bakar

Selain kasus kritis, pasien luka bakar mayor juga dikarakteristikkan dengan respons inflamasi yang memanjang. Injuri termal yang berat juga dihubungkan dengan meningkatnya kejadian infeksi, yang selalu dihubungkan dengan meningkatnya morbiditas dan mortalitas. Terapi nutrisi termasuk lemak sangat dibutuhkan untuk harapan hidup pasien. Meskipun sampai saat ini lemak masih dianggap eksklusif sebagai sumber energi, beberapa asam lemak, khususnya PUFA omega-3, eicosapentaenoic acid (EPA) dan docosahexaenoic (DHA) mempunyai peranan dalam pengaturan, khususnya berpengaruh terhadap struktur dan fungsi membran sel, metabolisme eikosanoid, produksi sitokin dan interaksi dalam mengatur respons imun inflamasi. Selain itu, juga pernah disebutkan bahwa tingginya dosis asupan lemak (≥ 35% energi total) meningkatkan komplikasi infeksi, akan tetapi pemberian PUFA omega-3 justru menurunkan komplikasi infeksi.

Dari literatur disebutkan bahwa dengan menambahkan PUFA omega-3 ke dalam formula enteral yang dikombinasi dengan nutrien imunomodulasi seperti arginin, glutamin, nukleotida, antioksidan, dan vitamin E, akan semakin menurunkan komplikasi infeksi yang disebabkan karena luka bakar. Akan tetapi, kombinasi berbagai macam komposisi tersebut membuat susah untuk diidentifikasi efek mana yang mempunyai peranan penting dalam luka bakar.

Efek PUFA omega-3 terhadap respons inflamasi telah diketahui, dan pada pasien luka bakar khas dengan inflamasi yang memanjang. Oleh karena itu, dilakukan penelitian apakah PUFA omega-3 dapat menurunkan komplikasi infeksi pada luka bakar. Desain penelitiannya adalah prospektif, acak, tersamar. Metodenya dengan mengumpulkan subjek luka bakar yang dirawat di ICU dengan luas luka bakarnya >15% body surface area (BSA), menggunakan ventilator selama >6 hari dan mendapatkan nutrisi enteral. Total subjek yang memenuhi kriteria 92 kemudian dibagi menjadi 2 kelompok secara acak, yaitu kelompok perlakuan mendapatkan nutrisi enteral yang ditambahkan dengan 50% lemak yang berasal dari fish oil (n=47) dan kelompok kontrol hanya mendapatkan nutrisi enteral standar saja (n=45). Kemudian parameter dinilai sebelum dan sesudah pemberian, yang dinilai adalah komplikasi infeksi (kejadian sepsis berat dan syok sepsis), residu lambung, lamanya penggunaan ventilator, dan mortalitas.

Hasilnya menunjukkan pada kelompok perlakuan terjadi penurunan yang bermakna terhadap terjadinya komplikasi infeksi (p=0,03) dan residu lambung (p<0,03). Akan tetapi, penggunaan ventilator dan mortalitas tidak ada perbedaan yang bermakna secara statistik. Dari penelitian dapat disimpulkan bahwa pemberian nutrisi enteral yang ditambahkan dengan 50% PUFA omega-3 dapat menurunkan komplikasi infeksi dan residu lambung, akan tetapi tidak berpengaruh terhadap mortalitas. (LAI)

Image : Ilustrasi
Referensi:
1.Serrana T, Estrella E. Effect of omega 3 polyunsaturated fatty acids derived from fish oil in major burn patients: A prospective randomized controlled pilot trial. Clinical Nutrition 2017;1:6.
2.Calder PC. Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? Br J Clin Pharmacol. 2013;75:645-62.

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