Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial
Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial
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DOI：
10.1016/s0140-6736(01)06578-3
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发表时间：
2001-11-03
期刊：
影响因子：
168.9
通讯作者：
Mariani, L
中科院分区：
文献类型：
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作者：
Bozzetti, F;Braga, M;Mariani, L
背景 尽管目前的观点倾向于使用肠内营养而不是肠外营养，但择期手术患者术后早期营养的临床益处尚未明确显示。我们的目的是检验以下假设：术后肠内营养比含有相似能量和氮量（112 kJ kg(-1)day(-1) 和 1.4 g 氨基酸 kg(-1)day(-1)）的肠外营养更好（术后并发症更少）。 方法 我们对营养不良的胃肠癌患者和候选者进行了一项随机多中心临床试验。 用于重大择期手术。 159 名患者被分配接受肠内营养，158 名患者接受肠外营养。主要终点是术后并发症的发生，次要终点是术后住院时间、不良反应和治疗交叉。分析按意向治疗进行。结果 肠内喂养的患者中有 54 名 (34%) 发生术后并发症，而肠外喂养的患者则有 78 名 (49%) 发生术后并发症（相对风险 0.69，95% CI 0.53-0.90，p=0.005）。肠内营养组和肠外营养组的术后住院时间分别为13.4天和15.0天（p=0.009）。 56 名 (35%) 肠内喂养患者出现不良反应，而 22 名 (14%) 肠外喂养患者出现不良反应 (2.50, 1.61-3.86, p
Background Although current opinion favours the use of enteral over parenteral nutrition, the clinical benefits of early postoperative nutrition in patients undergoing elective surgery have never been clearly shown. We aimed to test the hypothesis that postoperative enteral nutrition is better (fewer postoperative complications) than parenteral nutrition containing similar energy and nitrogen amounts (112 kJ kg(-1)day(-1) and 1.4 g aminoacid kg(-1)day(-1)).Methods We did a randomised multicentre clinical trial in patients with gastrointestinal cancer who were malnourished and candidates for major elective surgery. 159 patients were assigned to enteral nutrition and 158 to parenteral nutrition. The primary endpoint was the occurrence of postoperative complications, and secondary endpoints were length of postoperative hospital stay, adverse effects, and treatment crossover. Analysis was by intention to treat.Findings Postoperative complications occurred in 54 (34%) patients fed enterally versus 78 (49%) fed parenterally (relative risk 0.69, 95% CI 0.53-0.90, p=0.005). Length of postoperative stay was 13.4 days and 15.0 days in the enteral nutrition and parenteral nutrition groups, respectively (p=0.009). Adverse effects occurred in 56 (35%) patients fed enterally versus 22 (14%) patients fed parenterally (2.50, 1.61-3.86, p