Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Nutrition. 2018 Oct;54:68-75. doi: 10.1016/j.nut.2018.02.022. Epub 2018 Mar 20.
Postoperative early oral or enteral intake is a crucial element of the Enhanced Recovery After Surgery (ERAS) protocol. However, normal food intake or enteral feeding cannot be started early in the presence of coexisting bowel dysfunction in patients undergoing liver transplantation (LT). The aim of this multicenter, randomized, double-blinded, placebo-controlled trial was to determine the enhancement effects of the Japanese herbal medicine Daikenchuto (DKT) on oral/enteral caloric intake in patients undergoing LT.
A total of 112 adult patients undergoing LT at 14 Japanese centers were enrolled. The patients were randomly assigned to receive either DKT or placebo from postoperative day (POD) 1 to 14. The primary endpoints were total oral/enteral caloric intake, abdominal distension, and pain on POD 7. The secondary endpoints included sequential changes in total oral/enteral caloric intake after LT, and portal venous flow volume and velocity in the graft.
A total of 104 patients (DKT, n = 55; placebo, n = 49) were included in the analyses. There were no significant differences between the two groups in terms of primary endpoints. However, postoperative total oral/enteral caloric intake was significantly accelerated in the DKT group compared with the placebo group (P = 0.023). Moreover, portal venous flow volume (POD 10, 14) and velocity (POD 14) were significantly higher in the DKT group than in the placebo group (P = 0.047, P = 0.025, P = 0.014, respectively).
Postoperative administration of DKT may enhance total oral/enteral caloric intake and portal venous flow volume and velocity after LT and favorably contribute to the performance of the ERAS protocol.
术后早期口服或肠内摄入是加速康复外科（ERAS）方案的关键要素。然而，在接受肝移植（LT）的患者存在并存肠道功能障碍的情况下，无法早期开始正常进食或肠内喂养。本多中心、随机、双盲、安慰剂对照试验旨在确定日本草药大建中汤（DKT）对 LT 患者口服/肠内热量摄入的增强作用。
共有 14 个日本中心的 112 名成年 LT 患者入组。患者随机分配在术后第 1 天（POD）1 至 14 天接受 DKT 或安慰剂。主要终点是第 7 天的总口服/肠内热量摄入、腹胀和疼痛。次要终点包括 LT 后总口服/肠内热量摄入的连续变化，以及移植物门静脉血流容积和速度。
共有 104 例患者（DKT，n=55；安慰剂，n=49）纳入分析。两组在主要终点方面无显著差异。然而，与安慰剂组相比，DKT 组术后总口服/肠内热量摄入明显加快（P=0.023）。此外，DKT 组门静脉血流容积（POD 10、14）和速度（POD 14）明显高于安慰剂组（P=0.047、P=0.025、P=0.014）。
LT 术后给予 DKT 可能会增强总口服/肠内热量摄入以及门静脉血流容积和速度，有利于 ERAS 方案的实施。
