Rayes N, Seehofer D, Müller A R, Hansen S, Bengmark S, Neuhaus P
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité Campus Virchow, Augustenburger Platz l, 13355 Berlin, Germany.
Z Gastroenterol. 2002 Oct;40(10):869-76. doi: 10.1055/s-2002-35259.
Early enteral nutrition with fibre and probiotics has been effective in preventing bacterial translocation and is therefore expected to reduce the incidence of postoperative bacterial infections.
In a prospective randomized trial including 172 patients following major abdominal surgery or liver transplantation, the incidence of bacterial infections was compared in patients receiving either a) conventional parenteral or enteral nutrition, b) enteral nutrition with fibre and lactobacillus plantarum 299 or c) enteral nutrition with fibre and heat inactivated lactobacilli (placebo). Liver transplant recipients were also treated with selective bowel decontamination (SBD). Routine laboratory parameters, nutritional parameters and the cellular immune status were measured preoperatively and on postoperative days 1, 5 and 10.
Patients were comparable regarding preoperative ASA-classification, Child-Pugh classification of cirrhosis, operative data and immunosuppression. The incidence of bacterial infections after liver, gastric oder pancreas resection was 31 % in the conventional group a) compared to 4 % in the lactobacillus-group b) and 13 % in the placebo-group c). In the analysis of 95 liver transplant recipients, 13 % group b)-patients developed infections compared to 48 % group a)-patients and 34 % group c)-patients. The difference between groups a) and b) was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Cholangitis and pneumonia were the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases.
Fibre and probiotics could lower the incidence of bacterial infections following major abdominal surgery in comparison to conventional nutrition with or without SBD. With this new concept, costs can be reduced by shortening the duration of antibiotic therapy and sparing SBD.
含纤维和益生菌的早期肠内营养在预防细菌移位方面有效，因此有望降低术后细菌感染的发生率。
在一项前瞻性随机试验中，纳入了172例接受腹部大手术或肝移植的患者，比较了接受以下治疗的患者的细菌感染发生率：a）传统肠外或肠内营养；b）含纤维和植物乳杆菌299的肠内营养；c）含纤维和热灭活乳杆菌（安慰剂）的肠内营养。肝移植受者还接受了选择性肠道去污（SBD）治疗。术前以及术后第1、5和10天测量常规实验室参数、营养参数和细胞免疫状态。
患者在术前美国麻醉医师协会（ASA）分级、肝硬化的Child-Pugh分级、手术数据和免疫抑制方面具有可比性。在肝、胃或胰腺切除术后，传统a组的细菌感染发生率为31%，而乳杆菌b组为4%，安慰剂c组为13%。在对95例肝移植受者的分析中，b组13%的患者发生感染，而a组为48%，c组为34%。在这两种情况下，a组和b组之间的差异具有统计学意义。此外，乳杆菌组的抗生素治疗持续时间明显更短。胆管炎和肺炎是最常见的感染，肠球菌是最常分离出的细菌。在大多数情况下，纤维和乳杆菌耐受性良好。
与采用或不采用SBD的传统营养相比，纤维和益生菌可降低腹部大手术后细菌感染的发生率。采用这一新概念，可通过缩短抗生素治疗持续时间和省去SBD来降低成本。
