Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
University of Sydney, Sydney, New South Wales, Australia.
JPEN J Parenter Enteral Nutr. 2020 Jul;44(5):806-814. doi: 10.1002/jpen.1709. Epub 2019 Sep 18.
The effect of immunonutrition vs standard polymeric nutrition in the preoperative phase on patient outcomes is still unclear, which could be due to contributing factors such as poorly reported compliance and unequal provision of protein, energy, and volume. The aim of this study was to examine the effects of preoperative immunonutrition compared with standard polymeric supplements matched for energy, protein, volume, length of stay, and postoperative complications in pelvic exenteration surgery, taking into consideration compliance.
This was a single-blinded, randomized, controlled trial in patients undergoing pelvic exenteration surgery. Fifty-two participants were randomly assigned to consume 3 immunonutrition supplements/d for 5 days preoperatively, and 56 participants were randomly assigned to consume 3 standard polymeric supplements/d for 5 days preoperatively. Primary and secondary outcome measures were assessed. Compliance with each nutrition regime was recorded during the intervention, and subanalysis was conducted.
There was no significant difference between immunonutrition and standard polymeric supplements on length of stay (P = 0.988) or postoperative complications (P = 0.179) after pelvic exenteration surgery. Compliance with nutrition supplements was significantly less in malnourished (n = 33) compared with well-nourished participants (n = 74) (P = 0.016). Compliance varied between study groups, although not significant.
Preoperative immunonutrition did not significantly impact length of stay or postoperative complications compared with standard polymeric supplements after pelvic exenteration surgery, despite controlling for protein, energy, and volume. Compliance, protein, and energy may considerably impact the effect of immunonutrition, particularly in malnourished patients.
免疫营养与标准聚合营养在术前阶段对患者结局的影响尚不清楚，这可能是由于报告的依从性差以及蛋白质、能量和容量的提供不均等因素所致。本研究旨在检查与标准聚合补充剂相比，术前免疫营养在接受骨盆切除术的患者中的效果，同时考虑到依从性，这些补充剂在能量、蛋白质、容量、住院时间和术后并发症方面是匹配的。
这是一项在接受骨盆切除术的患者中进行的单盲、随机、对照试验。52 名参与者被随机分配每天接受 3 份免疫营养补充剂，术前 5 天服用，56 名参与者被随机分配每天接受 3 份标准聚合补充剂，术前 5 天服用。评估了主要和次要结局。在干预期间记录了对每种营养方案的依从性，并进行了亚分析。
免疫营养与标准聚合补充剂在骨盆切除术后的住院时间（P = 0.988）或术后并发症（P = 0.179）方面没有显著差异。与营养补充剂良好的参与者（n = 74）相比，营养不良的参与者（n = 33）的营养补充剂依从性显著较低（P = 0.016）。尽管存在差异，但研究组之间的依从性存在差异。
尽管控制了蛋白质、能量和容量，但与标准聚合补充剂相比，术前免疫营养并没有显著影响骨盆切除术后的住院时间或术后并发症。依从性、蛋白质和能量可能会对免疫营养的效果产生重大影响，尤其是在营养不良的患者中。
