CoCoS 试验：心脏手术患者的热量控制可提高生存率，这是一项采用回顾性对照的干预性试验。

The CoCoS trial: Caloric Control in Cardiac Surgery patients promotes survival, an interventional trial with retrospective control.

机构信息

Intensive Care Unit, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Intensive Care Unit, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

出版信息

Clin Nutr. 2018 Jun;37(3):864-869. doi: 10.1016/j.clnu.2017.03.007. Epub 2017 Mar 18.

DOI:10.1016/j.clnu.2017.03.007

PMID:28365080

Abstract

BACKGROUND & AIMS: Malnutrition is widespread among cardiac surgery patients and is independently related to an adverse postoperative evolution or outcome. We aimed to assess whether nutrition therapy (NT) could alter caloric deficit, morbidity, and mortality in patients scheduled for non-emergency coronary artery bypass graft (CABG) or aortic valve surgery.

METHODS

351 patients undergoing either elective CABG or aortic valve surgery were studied. Patients receiving NT were enrolled from January 2013 until December 2014. A retrospective control group (CT) consisted of 142 matched patients. The primary endpoint was to evaluate whether NT could limit caloric deficit (Intake to Need Deviation). Secondary endpoints addressed the potential effect of NT on morbidity and mortality. Patients were followed for one year after surgery.

RESULTS

There was no significant difference in patient, laboratory or mortality profile between the groups. Caloric deficit could be limited in the intervention group, essentially by providing oral feeding and oral supplements. A minority of patients required enteral or parenteral nutrition during their hospital stay. Caloric deficit increased after the second postoperative day because more patients were switched to oral feeding and intravenous infusions were omitted. Combining CABG and aortic valve surgery, male patients in the NT group had significantly less arrhythmia than in the CT group (7% versus 31%; P = 0.0056), while females in the NT group had significantly less pneumonia than in the CT group (7% versus 22%; P = 0.0183). Survival was significantly higher in female NT patients compared to CT patients, both for CABG (100% versus 83%; P = 0.0015) and aortic valve surgery (97% versus 78%; P = 0.0337).

CONCLUSION

The results suggest that NT beneficially affects morbidity and mortality in elective cardiac surgery patients. The impact of NT seems more pronounced in women than in men. Registration: Clinicaltrials.gov: NCT02902341.

摘要

背景与目的

营养不良在心脏外科患者中普遍存在，且与术后不良转归独立相关。本研究旨在评估营养治疗（NT）是否能改变择期行冠状动脉旁路移植术（CABG）或主动脉瓣手术患者的热量摄入不足、发病率和死亡率。

方法

研究纳入了 351 例行择期 CABG 或主动脉瓣手术的患者。2013 年 1 月至 2014 年 12 月，我们纳入了接受 NT 的患者，并设立了回顾性对照（CT）组，包括 142 例匹配患者。主要终点是评估 NT 是否能限制热量摄入不足（摄入与需求偏差）。次要终点是评估 NT 对发病率和死亡率的潜在影响。患者术后随访 1 年。

结果

两组患者的人口统计学、实验室和死亡率特征无显著差异。干预组通过提供口服喂养和口服补充剂，可有效限制热量摄入不足。少数患者在住院期间需要肠内或肠外营养。由于更多患者转为口服喂养，静脉输液被停用，术后第 2 天开始，热量摄入不足增加。在 NT 组中，与 CT 组相比，行 CABG 和主动脉瓣手术的男性患者心律失常明显减少（7% vs 31%；P=0.0056），而 NT 组女性患者肺炎明显减少（7% vs 22%；P=0.0183）。与 CT 组相比，女性 NT 患者的生存率显著更高，无论行 CABG（100% vs 83%；P=0.0015）还是主动脉瓣手术（97% vs 78%；P=0.0337）。