Von Meyenfeldt M F, Meijerink W J, Rouflart M M, Builmaassen M T, Soeters P B
Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Clin Nutr. 1992 Aug;11(4):180-6. doi: 10.1016/0261-5614(92)90026-m.
Ever since methods of artificial nutritional support became available, attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients. Many trials have addressed this question, but very few have given a meaningful answer because of conceptual and methodological flaws. We therefore undertook a prospective randomised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition (TPN) (n = 51) or total enteral nutrition (TEN) (n = 50) providing 150% basal energy expenditure (BEE) non-protein energy, to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion. 50 patients served as a depleted control group (D) and 49 patients served as a non-depleted reference group (ND) and were operated upon without delay. Depleted control patients suffered significantly more septic complications than did patients in the non-depleted reference group (p < 0.05). There was no significant difference, however, in septic complications between either of the nutritional support groups and the non-depleted control group. In high risk patients, with weight loss >10% of body weight and over 500 ml blood loss during operation, a significant decrease in major complications was observed (p < 0.05) as a result of nutritional support. We conclude that pre-operative nutritional support, in patients with severe depletion, results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients.
自从人工营养支持方法出现以来，人们一直尝试用这种治疗方式来降低外科手术患者的死亡率和发病率。许多试验都探讨了这个问题，但由于概念和方法上的缺陷，很少有试验给出有意义的答案。因此，我们进行了一项前瞻性随机试验，研究术前至少10天的全胃肠外营养（TPN）（n = 51）或全肠内营养（TEN）（n = 50）提供150%基础能量消耗（BEE）非蛋白质能量，对一组有消耗迹象的同质患者降低术后主要并发症和死亡率的影响。50名患者作为消耗对照组（D），49名患者作为非消耗参照组（ND），并立即进行手术。消耗对照组患者发生感染性并发症的情况明显多于非消耗参照组患者（p < 0.05）。然而，营养支持组与非消耗对照组之间在感染性并发症方面没有显著差异。在高危患者中，即体重减轻超过体重10%且手术期间失血超过500毫升的患者，营养支持使主要并发症显著减少（p < 0.05）。我们得出结论，术前营养支持对于严重消耗的患者，可使主要并发症减少到一定程度，证明在这一特定患者群体中常规使用是合理的。
