肝切除患者的术前免疫营养：一项前瞻性随机试验。
Preoperative immunonutrition in patients undergoing liver resection: A prospective randomized trial.
作者信息
Russell Kylie, Zhang Han-Guang, Gillanders Lyn K, Bartlett Adam Sjr, Fisk Helena L, Calder Philip C, Swan Peter J, Plank Lindsay D
机构信息
Nutrition Services, Auckland City Hospital, Auckland 1023, New Zealand.
Department of Surgery, University of Auckland, Auckland 1023, New Zealand.
出版信息
World J Hepatol. 2019 Mar 27;11(3):305-317. doi: 10.4254/wjh.v11.i3.305.
BACKGROUND
Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection.
AIM
To evaluate the effects of preoperative nutritional supplementation enriched with arginine and -3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection.
METHODS
Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30.
RESULTS
A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 ( 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group ( 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group ( 0.087). Median hospital stay was 9 (range 4-49) d in the IMN group and 8 (3-34) d in the STD group ( 0.476).
CONCLUSION
In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.
背景
多项系统评价表明，术前补充包括精氨酸和n-3脂肪酸在内的免疫营养素可减少接受胃肠道手术患者的感染并发症。然而，关于富含精氨酸和n-3脂肪酸的营养补充对接受肝切除术患者的益处，现有信息有限。
目的
评估术前补充富含精氨酸和-3脂肪酸的营养对接受肝切除术患者炎症和免疫标志物及临床结局的影响。
方法
34例接受肝切除术的患者被随机分为两组，一组术前5天接受Impact[1020千卡/天，免疫营养（IMN）组]，另一组接受标准护理[不补充，标准护理（STD）组]。研究开始时通过主观全面评定法（SGA）测量营养状况。在研究开始时、手术前一天、术后第（POD）7天和30天进行功能评估（握力、疲劳和体能状态）。在研究开始时、手术前一天、POD 1、3、5、7、10和30天测量炎症和免疫标志物。前瞻性记录术后并发症直至POD30。
结果
共分析了32例患者（17例IMN组和15例STD组）。除4例患者外，所有患者均为SGA A级。在手术前一天以及POD 1、3、5和7天，IMN组患者血浆中（二十碳五烯酸加二十二碳六烯酸）与花生四烯酸的比值较高（P<0.05）。IMN组血浆白细胞介素（IL）-6浓度升高（POD7时P<0.017）。在功能指标、免疫反应（白细胞计数和总淋巴细胞）或炎症标志物（C反应蛋白、肿瘤坏死因子-α、IL-8、IL-10）方面未检测到治疗效果。IMN组有10例患者发生感染并发症，STD组有4例（P=0.087）。IMN组中位住院时间为9天（范围4-49天），STD组为8天（3-34天）（P=0.476）。
结论
在接受择期肝切除术的营养良好的患者中，本研究未能显示术前免疫营养有任何益处。
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