Matzi Veronika, Lindenmann Joerg, Muench Andreas, Greilberger Joachim, Juan Heinz, Wintersteiger Reinhard, Maier Alfred, Smolle-Juettner Freyja Maria
Department of Surgery, Division of Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria.
Eur J Cardiothorac Surg. 2007 Nov;32(5):776-82. doi: 10.1016/j.ejcts.2007.07.016. Epub 2007 Sep 4.
Preoperative micronutrient supplementation in fast-track surgery programs have shown to reduce complications, shorten recovery, and thereby lower costs. In a prospective randomized study, the metabolic effects of a combination of alpha-ketoglutaric acid (alpha-KG) and 5-hydroxymethylfurfural (5-HMF) were evaluated concerning their impact on improvement of exercise capacity and reduction of oxidative stress in lung surgery.
Thirty-two consecutive patients admitted for lung resection due to NSCLC were randomized to the study protocol. All patients received preoperative nutritional guidelines according to general recommendations. In 16 (study group), a supplementation of 7.2g alpha-KG and 720 mg 5-HMF/day (SANOPAL) was administered from days 1 to 10. Spiroergometric evaluation was carried out at baseline and day 10 after micronutrient supplementation. Blood samples for the determination of oxidative stress, i.e. carbonyl proteins (CPs) and isoprostanes (IPs) were taken on at baseline, in the operating room just before resection treatment, and 25 min after single lung ventilation (SLV).
Spiroergometric re-evaluation showed a significant increase of VO2max (p=0.0108) and Watt's (p=0.011) in favor of the study group. Determination of oxidative stress showed a significant reduction of CPs before (p=0.048) and after SLV (p=0.0001) for the study group compared to the control group. The same is true for IPs before (p=0.003) and after SLV (p=0.02). Hospitalization and intensive care unit (ICU) of the study group showed a significant reduction compared to the control group (p=0.03 and p=0.02, respectively).
Simple oral supplementation using a combination of alpha-KG and 5-HMF of preoperative micronutrition may therefore be one further step in a multimodality approach of fast-track surgery programs also in lung surgery.
快速康复外科计划中的术前微量营养素补充已显示可减少并发症、缩短恢复时间，从而降低成本。在一项前瞻性随机研究中，评估了α-酮戊二酸（α-KG）和5-羟甲基糠醛（5-HMF）组合的代谢效应，及其对肺手术中运动能力改善和氧化应激降低的影响。
32例因非小细胞肺癌入院接受肺切除术的连续患者被随机分配至研究方案。所有患者均根据一般建议接受术前营养指导。16例（研究组）患者从第1天至第10天每天补充7.2gα-KG和720mg5-HMF（SANOPAL）。在基线和微量营养素补充后第10天进行运动心肺功能评估。在基线、切除治疗前的手术室以及单肺通气（SLV）后25分钟采集血样，用于测定氧化应激指标，即羰基蛋白（CPs）和异前列腺素（IPs）。
运动心肺功能重新评估显示，研究组的最大摄氧量（p = 0.0108）和瓦特数（p = 0.011）显著增加。氧化应激测定显示，与对照组相比，研究组在SLV前（p = 0.048）和SLV后（p = 0.0001）的CPs显著降低。IPs在SLV前（p = 0.003）和SLV后（p = 0.02）也是如此。与对照组相比，研究组的住院时间和重症监护病房（ICU）停留时间显著缩短（分别为p = 0.03和p = 0.02）。
因此，术前微量营养中使用α-KG和5-HMF组合进行简单口服补充，可能是快速康复外科计划多模式方法中的又一步，在肺手术中亦是如此。
