de Luis D A, Izaola O, Cuellar L, Terroba M C, Martin T, Aller R
Medicine School and Unit of Investigation, Institute of Endocrinology and Nutrition, Hospital Rio Hortega, University of Valladolid, Valladolid, Spain.
Eur J Clin Nutr. 2007 Feb;61(2):200-4. doi: 10.1038/sj.ejcn.1602515. Epub 2006 Aug 23.
Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine-enhanced diet (17 g/day) than previous studies, could improve nutritional variables as well as clinical outcomes, when compared with a control enteral diet.
Randomized clinical trial.
Tertiary care.
A population of 72 patients with oral and laryngeal cancer was enrolled.
At surgery, patients were randomly allocated to two groups: (a) 35 patients receiving an arginine-enhanced formula with arginine (group I) and (b) 37 patients receiving an isocaloric, isonitrogenous enteral formula (group II).
No significant intergroup differences in the trend of the three plasma proteins (albumin, transferrin, prealbumin) and lymphocytes were detected. Episodes of diarrhea rate were equal in both groups (22.8% group I and 21.6% group II: NS). The postoperative infections complications were equal in both groups (5.7% group I and 5.4% group II: NS). Fistula (wound complication) was less frequent in enriched nutrition group (2.8% group I and 18.9% group II: P<0.05), whereas wound infection was similar in both groups. The length of postoperative stay was similar in both (27.9+/-21 vs 28.2+/-12 days; NS).
At this dose, arginine-enhanced formula improves fistula rates in postoperative head and neck cancer patients without a high rate of diarrhea.
接受手术的头颈癌患者术后并发症发生率较高。我们研究的目的是调查，与对照肠内饮食相比，使用比以往研究更高剂量精氨酸强化饮食（17克/天）对头颈癌患者进行术后营养支持，是否能改善营养指标以及临床结局。
随机临床试验。
三级医疗机构。
纳入72例口腔和喉癌患者。
手术时，患者被随机分为两组：（a）35例患者接受含精氨酸的精氨酸强化配方（第一组）；（b）37例患者接受等热量、等氮的肠内配方（第二组）。
未检测到两组间三种血浆蛋白（白蛋白、转铁蛋白、前白蛋白）及淋巴细胞变化趋势的显著差异。两组腹泻发生率相同（第一组22.8%，第二组21.6%：无统计学差异）。两组术后感染并发症发生率相同（第一组5.7%，第二组5.4%：无统计学差异）。强化营养组瘘管（伤口并发症）发生率较低（第一组2.8%，第二组18.9%：P<0.05），而两组伤口感染情况相似。两组术后住院时间相似（27.9±21天 vs 28.2±12天；无统计学差异）。
在此剂量下，精氨酸强化配方可降低头颈癌患者术后瘘管发生率，且腹泻发生率不高。
