Rayes Nada, Hansen Sonja, Seehofer Daniel, Müller Andrea Raffaela, Serke Stefan, Bengmark Stig, Neuhaus Peter
Department of Surgery, Charité, Campus Virchow, Augustenberger Platz 1, 13355 Berlin, Germany.
Nutrition. 2002 Jul-Aug;18(7-8):609-15. doi: 10.1016/s0899-9007(02)00811-0.
Early enteral nutrition with fiber-containing solutions plus Lactobacillus may reduce bacterial translocation and minimize the incidence of infections after surgery.
In a prospective, randomized trial in three groups (n = 30/group) of patients after major abdominal surgery, we compared our previous regimen with parenteral nutrition or fiber-free enteral nutrition (group A) with enteral fiber-containing nutrition with living Lactobacillus (group B) and heat-killed Lactobacillus (group C). The main endpoint was the development of bacterial infection. Other analyzed parameters were the durations of antibiotic therapy and hospital stay, non-infectious complications, side effects of the nutrition, and onset of bowel movement. Routine parameters, nutritional parameters, and cellular immune status in the blood were measured preoperatively and on 1, 5, and 10 d postoperatively.
The incidence of infections was significantly lower (P = 0.01) in groups B and C with enteral nutrition containing fibers (10% each) than in group A (30%). Patients in group B received antibiotics for a significantly shorter time (P = 0.04) than did the patients in groups A and C. The length of hospital stay and the incidence of non-infectious complications did not differ significantly. Fibers and lactobacilli were well tolerated. There were no general benefits of living Lactobacillus as opposed to heat-killed Lactobacillus in the entire study population, but benefits were observed in the patients with gastric and pancreas resections, although no statistical analysis was done due to their small numbers.
Early enteral nutrition with fiber-containing solutions reduced the rate of postoperative infections in comparison with parenteral nutrition and fiber-free enteral formula. Addition of living Lactobacillus seemed to increase the benefits in patients with gastric and pancreatic resections.
使用含纤维溶液加乳酸菌进行早期肠内营养，可能会减少细菌移位，并将术后感染的发生率降至最低。
在一项针对三组（每组n = 30）腹部大手术后患者的前瞻性随机试验中，我们将之前的方案（肠外营养或不含纤维的肠内营养，A组）与含活性乳酸菌的含纤维肠内营养（B组）和热灭活乳酸菌（C组）进行了比较。主要终点是细菌感染的发生情况。其他分析参数包括抗生素治疗时间、住院时间、非感染性并发症、营养的副作用以及排便开始时间。术前以及术后第1、5和10天测量血液中的常规参数、营养参数和细胞免疫状态。
含纤维（各含10%）的肠内营养B组和C组的感染发生率（各为10%）显著低于A组（30%）（P = 0.01）。B组患者接受抗生素治疗的时间明显短于A组和C组患者（P = 0.04）。住院时间和非感染性并发症的发生率没有显著差异。纤维和乳酸菌耐受性良好。在整个研究人群中，活性乳酸菌与热灭活乳酸菌相比没有总体优势，但在胃和胰腺切除患者中观察到了益处，不过由于人数较少未进行统计分析。
与肠外营养和不含纤维的肠内配方相比，使用含纤维溶液进行早期肠内营养可降低术后感染率。添加活性乳酸菌似乎对胃和胰腺切除患者有更多益处。
