Carr C S, Ling K D, Boulos P, Singer M
Department of Cardiothoracic Surgery, University College London Medical School, Middlesex Hospital, London.
BMJ. 1996 Apr 6;312(7035):869-71. doi: 10.1136/bmj.312.7035.869.
To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective.
Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet.
Teaching hospitals in London.
30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection.
Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome.
Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005).
Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.
评估胃肠道切除术后患者立即进行肠内喂养是否安全有效。
通过鼻空肠管进行术后立即肠内喂养与传统术后静脉输液直至恢复正常饮食的随机试验。
伦敦的教学医院。
30名在参与的顾问外科医生照料下的患者，他们因静止性慢性胃肠道疾病接受择期剖腹手术，以期进行胃肠道切除。两名患者未进行切除手术。
营养状况、营养摄入和氮平衡、通过乳果糖 - 甘露醇差异糖吸收试验测量的肠黏膜通透性、并发症及结局。
所有14例患者均成功实现了术后立即肠内喂养，在恢复口服饮食前，平均（标准差）每日摄入量为6.78（1.57）兆焦耳（1622（375）千卡），而接受静脉输液的患者为1.58（0.14）兆焦耳（377（34）千卡）（P<0.0001）。术后第一天，接受静脉输液的患者尿氮平衡为负，而所有14例接受肠内喂养的患者均为正（平均（标准差）-13.2（11.6）克对5.3（2.7）克；P<0.005）。到第5天无差异。肠内喂养组肠黏膜通透性无变化，但接受静脉输液的患者与术前相比试验比值显著增加（0.11（0.06）对0.15（0.12）；P<0.005）。肠内喂养组术后并发症也较少（P<0.005）。
肠道切除术后患者立即进行肠内喂养似乎是安全的，可防止肠黏膜通透性增加，并产生正氮平衡。
