Kemen M, Senkal M, Homann H H, Mumme A, Dauphin A K, Baier J, Windeler J, Neumann H, Zumtobel V
Department of Surgery, Ruhr-University Bochum, St. Josef Hospital, FRG.
Crit Care Med. 1995 Apr;23(4):652-9. doi: 10.1097/00003246-199504000-00012.
To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies.
Prospective, randomized, placebo-controlled, double-blind study.
Surgical intensive care unit (ICU) in a German university hospital.
Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer.
Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5.
Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05).
Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.
评估术后早期给予富含精氨酸、核糖核酸（RNA）和ω-3脂肪酸的营养完全肠内饮食对接受上消化道（GI）恶性肿瘤手术患者免疫功能的影响。
前瞻性、随机、安慰剂对照、双盲研究。
德国一家大学医院的外科重症监护病房（ICU）。
42例连续接受胃肠道癌手术后经针导管空肠造口给予肠内饮食的患者。
患者被随机分为接受补充精氨酸、RNA和ω-3脂肪酸的饮食或等热量、等氮的安慰剂饮食。术后第1天在外科ICU开始早期肠内营养，速度为20 mL/小时，到术后第5天逐渐增加至最佳目标速度80 mL/小时。
每天记录临床检查和胃肠道不良症状。每周测定两次体重。通过激光散射比浊法测定免疫球蛋白浓度。采用改良酶联免疫吸附测定法测量γ-干扰素浓度。进行荧光激活细胞扫描流式细胞术分析B细胞、T淋巴细胞及其亚群。两组患者的临床特征和平均热量摄入相似，两种配方的耐受性均良好。补充饮食组术后第10天和第16天的T淋巴细胞及其亚群、辅助性T细胞（CD4）和活化T细胞（CD3、HLA-DR）数量显著更高（p < 0.05）。补充饮食组术后第16天经植物血凝素刺激后的平均γ-干扰素浓度更高。与安慰剂组相比，补充饮食组术后第10天的平均免疫球蛋白M浓度显著更高，术后第16天的平均免疫球蛋白G浓度更高（p < 0.05）。补充饮食组术后第7天和第10天的B淋巴细胞指数显著高于安慰剂饮食组（p < 0.05）。
术后早期在肠内饮食中补充精氨酸、RNA和ω-3脂肪酸可改善术后免疫反应，并有助于更快克服手术创伤后的免疫抑制。
