Department of Biosurgery and Surgical Technology, Imperial College, St. mary's Hospital, London, United Kingdom.
Scand J Surg. 2010;99(3):153-61. doi: 10.1177/145749691009900310.
current studies suggest immunonutrition decreases the inflammatory process, infection rates and reduces length of hospital stay in surgical patients, however studies are often conducted on heterogeneous groups of patients with varying composition of the immuno-nutrition. We aim to investigate the effect of immunonutrition on patients undergoing major upper gastrointestinal surgery by assessment of (i) the inflammatory and immune response and (ii) changes in clinical outcome when compared to a randomised control receiving conventional feeding.
a prospective double-blind randomised controlled study was undertaken to compare a feed supplemented with glutamine, arginine, -3 fatty acids and tributyrin, vitamin C, E and B-carotene and micronutrients (zinc, selenium and chromium) to an isonitrogenous, isocaloric control feed in patients undergoing major upper GI surgery. The primary end-points were defined as C-reactive protein (CRP), prealbumin and retinol binding protein (RBP) levels. Secondary end-points included performance scoring systems, length of hospital stay, adverse events and protein and nutrient assays. Variables were measured pre-operatively and routinely up to the 4th post-operative day.
there was no statistically significant change in primary end-points between the immunonutrition group and the control group. There was no difference in length of hospital stay between the groups. The vitamin C level in the study group was significantly higher at the end of the study period. Both groups tolerated the feeds well with adequate target feeding rate. There were no other significant changes in clinical outcomes between the two groups.
this study has not shown a benefit of immunonutrition through changes in inflammatory or nutritional markers, a decrease in length of hospital stay, or other morbidity. This may be because of inadequate numbers recruited to the study. Further, multi-centre, randomised trials on homogeneous patient groups are necessary to investigate the role of immunonutrition in major upper GI surgery.
目前的研究表明免疫营养可减少外科手术患者的炎症反应、感染率并缩短住院时间，但这些研究通常针对的是具有不同免疫营养成分的异质患者群体。我们旨在通过评估（i）炎症和免疫反应，以及（ii）与接受常规喂养的随机对照相比，临床结局的变化，来研究免疫营养对接受重大上消化道手术的患者的影响。
进行了一项前瞻性双盲随机对照研究，比较了一种添加谷氨酰胺、精氨酸、ω-3 脂肪酸和三丁酸甘油、维生素 C、E 和β-胡萝卜素以及微量营养素（锌、硒和铬）的饲料与一种等氮、等热量的对照饲料在上消化道重大手术患者中的作用。主要终点定义为 C 反应蛋白（CRP）、前白蛋白和视黄醇结合蛋白（RBP）水平。次要终点包括表现评分系统、住院时间、不良事件以及蛋白质和营养素测定。变量在术前和术后第 4 天常规测量。
免疫营养组和对照组的主要终点均无统计学显著变化。两组的住院时间无差异。研究组的维生素 C 水平在研究结束时显著升高。两组均能很好地耐受喂养，达到了足够的目标喂养率。两组之间在临床结局方面没有其他显著变化。
本研究未显示免疫营养通过改变炎症或营养标志物、缩短住院时间或其他发病率来带来益处。这可能是由于研究招募的人数不足。此外，有必要进行多中心、随机试验，以研究免疫营养在重大上消化道手术中的作用。
