Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V
Department of Surgery, Scientific Institute San Raffaele, University of Milan, Italy.
Crit Care Med. 1998 Jan;26(1):24-30. doi: 10.1097/00003246-199801000-00012.
To evaluate the impact of the route of administration of artificial nutrition and the composition of the diet on outcome.
Prospective, randomized, clinical trial.
Department of surgery, university hospital.
One hundred sixty-six consecutive patients undergoing curative surgery for gastric or pancreatic cancer.
At operation, the patients were randomized into three groups to receive: a) a standard enteral formula (control group; n = 55); b) the same enteral formula enriched with arginine, RNA, and omega-3 fatty acids (enriched group; n = 55); and c) total parenteral nutrition (TPN group; n = 56). The three regimens were isocaloric and isonitrogenous. Enteral nutrition was started within 12 hrs following surgery. The infusion rate was progressively increased to reach the nutritional goal (25 kcal/kg/day) on postoperative day 4.
Tolerance of enteral feeding, rate and severity of postoperative complications, and length of hospital stay were recorded. Early enteral infusion was well tolerated. Side effects were recorded in 22.7% of the patients, but only 6.3% did not reach the nutritional goal. The enriched group had a lower severity of infection than the parenteral group (4.0 vs. 8.6; p < .05). In subgroups of malnourished (n = 78) and homologous transfused patients (n = 42), the administration of the enriched formula significantly reduced both severity of infection and length of stay compared with the parenteral group (p < .05). Moreover, in transfused patients, the rate of septic complications was 20.0% in the enriched group, 38.4% in the control group, and 42.8% in the TPN group.
Early enteral feeding is a suitable alternative to TPN after major abdominal surgery. The use of the enriched diet appears to be more beneficial in malnourished and transfused patients.
评估人工营养的给药途径和饮食组成对结局的影响。
前瞻性、随机临床试验。
大学医院外科。
166例连续接受胃癌或胰腺癌根治性手术的患者。
手术时，将患者随机分为三组，分别接受：a）标准肠内营养配方（对照组；n = 55）；b）添加精氨酸、RNA和ω-3脂肪酸的相同肠内营养配方（强化组；n = 55）；c）全肠外营养（TPN组；n = 56）。三种方案的热量和氮量相等。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天达到营养目标（25千卡/千克/天）。
记录肠内喂养的耐受性、术后并发症的发生率和严重程度以及住院时间。早期肠内输注耐受性良好。22.7%的患者记录有副作用，但只有6.3%未达到营养目标。强化组的感染严重程度低于肠外营养组（4.0对8.6；p < 0.05）。在营养不良亚组（n = 78）和接受同源输血的患者亚组（n = 42）中，与肠外营养组相比，给予强化配方显著降低了感染严重程度和住院时间（p < 0.05）。此外，在输血患者中，强化组的脓毒症并发症发生率为20.0%，对照组为38.4%，TPN组为42.8%。
腹部大手术后，早期肠内喂养是TPN的合适替代方法。在营养不良和输血患者中，使用强化饮食似乎更有益。
