Braga M, Vignali A, Gianotti L, Cestari A, Profili M, Di Carlo V
Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
Infusionsther Transfusionsmed. 1995 Oct;22(5):280-4. doi: 10.1159/000223143.
To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients.
Randomised controlled study.
Surgical intensive care unit of a university hospital.
77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer.
Patients were randomised into 3 groups to receive: a standard enteral formula (n=24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26), isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets. and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated.
In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), RBP (p<0.005), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups.
These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.
评估术后早期给予癌症患者强化肠内营养的效果。
随机对照研究。
大学医院的外科重症监护病房。
77例连续接受胃癌或胰腺癌根治性手术的患者。
患者被随机分为3组，分别接受：标准肠内营养配方（n = 24）；添加精氨酸、RNA和ω-3脂肪酸的相同配方（n = 26）；等氮等热量的全肠外营养（n = 27）。术后12小时内开始肠内营养。输注速率逐渐增加，在术后第4天达到全量。入院时、术后第1天和第8天，进行以下测量：血清总铁结合力、白蛋白、前白蛋白、视黄醇结合蛋白（RBP）和胆碱酯酶水平。还评估迟发型超敏反应（DHR）、IgG、IgM、IgA、淋巴细胞亚群和单核细胞吞噬能力。术前以及术后第2天、第7天和第11天进行生物电阻抗分析。评估术后感染的发生率和严重程度以及住院时间。
所有患者术后第1天营养和免疫参数均显著下降。仅在接受强化饮食的组中，术后第8天前白蛋白（p < 0.02）、RBP（p < 0.005）、单核细胞吞噬能力（p < 0.001）和DHR（p < 0.005）显著增加。与其他组相比，接受强化饮食的组术后感染严重程度和术后住院时间显著缩短。
这些数据表明，术后早期接受强化肠内营养的癌症患者的营养和免疫状况以及临床结局有所改善。
