Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: A randomized, clinical trial
Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: A randomized, clinical trial
复制标题
DOI：
10.1177/014860710002400107
复制
发表时间：
2000-01-01
影响因子：
3.4
通讯作者：
Piacenza, S
中科院分区：
文献类型：
--
作者：
Bozzetti, F;Gavazzi, C;Piacenza, S
背景：研究围手术期全肠外营养（TPN）对于降低营养不良癌症患者手术风险的潜在益处的临床试验产生了有争议的结果。方法：90 名患有胃或结直肠肿瘤且体重减轻 10% 或以上的择期手术患者被随机分配到术前 10 天和术后 9 天的营养组，而对照组则为简单对照组。每日每公斤体重 TPN 方案包括每公斤 34.6 +/- 6.3 kcal 非蛋白质和 0.25 +/- 0.04 g 氮，液体体积为 42.6 +/- 7.3 mt。葡萄糖与脂肪的热量比为70:30。对照患者术前不接受营养，但术后接受940 kcal非蛋白质加85 g氨基酸。结果：接受 TPN 的患者中有 37% 发生并发症，对照组患者则为 57% (p = .03)。非感染性并发症主要是造成这一差异的原因，分别为 12% 和 34% (p = .02)。对照组患者中仅有 5 名患者死亡 (p = .05)。 TPN 患者的总住院时间比对照组长 (p = .00)，而两组的术后住院时间没有显着差异。结论：本研究表明，术前持续 10 天的 TPN 并在术后继续治疗，能够将并发症发生率降低约三分之一，并预防严重营养不良的胃肠癌患者的死亡。
Background: Clinical trials investigating the potential benefits of perioperative total parenteral nutrition (TPN) for reducing the risk of surgery in malnourished cancer patients have yielded controversial results. Methods: Ninety elective surgical patients with gastric or colorectal tumors and weight loss of 10% or more of usual body weight were randomly assigned to 10 days of preoperative and 9 days of postoperative nutrition vs a simple control group. The daily per kilogram body weight TPN regimen included 34.6 +/- 6.3 kcal nonprotein and 0.25 +/- 0.04 g nitrogen per kilogram in a volume of 42.6 +/- 7.3 mt of fluid. The glucose-to-fat calorie ratio was 70:30. Control patients did not receive preoperative nutrition but received 940 kcal nonprotein plus 85 g amino acids postoperatively. Results: Complications occurred in 37% of the patients receiving TPN us 57% of the control patients (p = .03). Noninfectious complications mainly accounted for this difference, which was 12% us 34%, respectively (p = .02). Mortality occurred in only 5 of the control group patients (p = .05). The total length of hospitalization for TPN patients was longer than for control (p = .00), whereas the length of postoperative stay in the two groups did not differ significantly. Conclusions: This study shows that 10 days of preoperative TPN that is continued postoperatively is able to reduce the complication rate by approximately one third and to prevent mortality in severely malnourished patients with gastrointestinal cancer.