Daly J M, Lieberman M D, Goldfine J, Shou J, Weintraub F, Rosato E F, Lavin P
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104.
Surgery. 1992 Jul;112(1):56-67.
The individual nutrients arginine, RNA, and omega-3 fatty acids improve immune function, but prospective trials have not demonstrated their effects on clinical outcome. Patients (n = 85) who underwent operation for upper gastrointestinal malignancies were randomized to receive the supplemental diet or a standard enteral diet after surgery. Clinical patient characteristics were similar between the two groups. Mean caloric intakes (1421 vs 1285 kcal/day) were similar between groups. Mean nitrogen intakes (15.6 vs 9.0 gm/day) and nitrogen balances (-2.2 vs -6.6 gm/day) measured in the first 20 patients were significantly greater in the supplemented group than in the standard group (p = 0.05). In vitro lymphocyte mitogenesis was measured in the first 31 patients and was decreased on postoperative day 1 in both groups, but normal levels were regained only in the supplemented group. In the cohort of 77 eligible patients, infectious and wound complications occurred significantly less often (11% vs 37%) in the supplemented group than in the standard group (p = 0.02). Linear logistic models for infectious/wound complications with control for the amount of nitrogen suggested (p = 0.10) dietary treatment as the major factor. Mean length of stay in the hospital was significantly shorter (p = 0.01) for the supplemented group (15.8 +/- 5.1 days) than for the standard group (20.2 +/- 9.4 days). These results suggest that postoperative enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids instead of a standard enteral diet significantly improved immunologic, metabolic, and clinical outcomes in patients with upper gastrointestinal malignancies who were undergoing major elective surgery.
精氨酸、RNA和ω-3脂肪酸等单一营养素可改善免疫功能，但前瞻性试验尚未证明它们对临床结局的影响。85例接受上消化道恶性肿瘤手术的患者术后被随机分为接受补充饮食组或标准肠内饮食组。两组患者的临床特征相似。两组的平均热量摄入相似（分别为1421和1285千卡/天）。对前20例患者测量的平均氮摄入量（分别为15.6和9.0克/天）和氮平衡（分别为-2.2和-6.6克/天），补充组显著高于标准组（p = 0.05）。对前31例患者进行了体外淋巴细胞有丝分裂测定，两组术后第1天均下降，但仅补充组恢复到正常水平。在77例符合条件的患者队列中，补充组的感染和伤口并发症发生率显著低于标准组（11%对37%，p = 0.02）。控制氮含量的感染/伤口并发症线性逻辑模型表明（p = 0.10）饮食治疗是主要因素。补充组的平均住院时间（15.8±5.1天）显著短于标准组（20.2±9.4天，p = 0.01）。这些结果表明，对于接受大型择期手术的上消化道恶性肿瘤患者，术后采用补充精氨酸、RNA和ω-3脂肪酸的肠内营养而非标准肠内饮食，可显著改善免疫、代谢和临床结局。
