Perioperative nutrition in malnourished surgical cancer patients - A prospective, randomized, controlled clinical trial
Perioperative nutrition in malnourished surgical cancer patients - A prospective, randomized, controlled clinical trial
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DOI：
10.1016/j.clnu.2011.07.007
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发表时间：
2011-12-01
影响因子：
6.3
通讯作者：
Kulig, Jan
中科院分区：
文献类型：
--
作者：
Klek, Stanislaw;Sierzega, Marek;Kulig, Jan
背景和目的：营养不良的手术患者应该从围手术期营养中受益。然而，目前尚不清楚肠内干预是否真的超越肠外干预，以及标准配方的修改是否重要。本研究的目的是评估围手术期营养支持途径和类型的临床价值。方法：2001年6月至2008年12月期间手术的167名营养不良患者（91名男性，76名女性，平均年龄61.4岁）在术后根据营养干预随机分为四组：肠内和肠外、标准或免疫调节。所有患者术前均接受肠外营养14天，为术后评估提供同质组。该试验旨在检验肠内营养和/或免疫营养可以降低术后并发症发生率的假设。结果：所有四组中个体并发症的发生率具有可比性（p > 0.05）。接受标准饮食的 84 名患者中有 23 名发生感染并发症，接受免疫调节配方的 83 名患者中有 20 名发生感染并发症（比值比 0.84；95% Cl 0.42 至 1.69）。接受肠内配方奶粉（24/84 例）和肠外配方奶粉（19/83 例）的患者感染并发症的比例没有显着差异。免疫调节配方奶粉和肠内喂养均未显着影响住院时间、总体发病率和死亡率。结论：结果表明，无论采用何种途径和配方，术后营养干预都会产生可比的结果，并且术前干预至关重要。该研究已在临床试验数据库中注册 - 编号：NCT 00558155。(C) 2011 Elsevier Ltd 和欧洲临床营养与代谢学会。版权所有。
Background & aims: Malnourished surgical patients are supposed to benefit from perioperative nutrition. It is unclear, however, whether enteral intervention really surpasses the parenteral one, and whether the modification of standard formula matters. The aim of the study was to evaluate the clinical value of the route and type of perioperative nutritional support.Methods: A group of 167 malnourished patients (91 M, 76 F. mean age 61.4 years) operated between June 2001 and December 2008 was randomly assigned during postoperative period to four groups according to nutritional intervention: enteral and parenteral, standard or immunomodulating. All patients received parenteral nutrition before surgery for 14 days, which provided homogenous groups for the postoperative evaluation. The trial was designed to test the hypothesis that enteral nutrition and/or immunonutrition can reduce the incidence of postoperative complications.Results: The incidence of individual complications was comparable among all four groups (p > 0.05). Infectious complications occurred in 23 of 84 patients with standard diets and in 20 of 83 patients receiving immunomodulatory formula (odds ratio 0.84; 95% Cl 0.42 to 1.69). There were no significant differences in infectious complications' ratio in patients receiving enteral (24/84 patients) and parenteral formulas (19/83 patients). Neither immunomodulating formulas nor enteral feeding significantly affected the length of hospitalization, overall morbidity and mortality rates.Conclusions: Results demonstrated that postoperative nutritional intervention generates comparable results regardless of the route and formula used and that preoperative intervention is of the utmost importance. The study was registered in the Clinical Trials Database - number: NCT 00558155. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.