Influence of early postoperative enteral nutrition versus placebo on cell mediated immunity, as measured with the Multitest® CMI
Influence of early postoperative enteral nutrition versus placebo on cell mediated immunity, as measured with the Multitest® CMI
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DOI：
10.1080/00365529950172907
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发表时间：
1999-01-01
影响因子：
1.9
通讯作者：
Brandstrup, B
中科院分区：
文献类型：
--
作者：
Beier-Holgersen, R;Brandstrup, B
背景：手术后变无反应性的患者死亡率很高，主要是由于感染并发症。早期研究表明，术前皮肤休息对胃肠道手术的临床结局具有预测价值。本研究采用Multitest（R）CMI研究了术后早期肠内营养与安慰剂对细胞介导免疫的影响，并将结果与临床结局和术前营养状态相关联。方法：60例患者随机接受肠内营养或安慰剂。根据术前营养状况对所有患者进行分层。术前2天、术后第1天和第5天进行CMI测试。所有检查均由同一研究者进行并记录。结果：两组之间的评分无显著差异。9名患者营养不良。术前营养状况无显著差异，但营养不良患者术后第3天的中位数较低。在有并发症的患者中，术前中位CMI评分为17.0 mm（95%置信限，10.5-24 mm），在无并发症的患者中为9.5 mm（95%置信限，5.5-16 mm）。这一结果是显著和出乎意料的。10例患者术前无反应性，其中3例发生并发症（30%）。总体并发症发生率为27/60（45%）。免疫状态从术前反应到术后无反应的变化与严重并发症显著相关（P = 0.043）。结论：早期肠内营养不影响CMI评分。术前无反应性与死亡率/发病率增加无关，而CMI对无反应性的反应变化是显著的。
Background: Patients who become anergic after surgery have a very high death rate, mainly due to infectious complications. It has earlier been shown that preoperative skin resting has predictive value for the clinical outcome in gastrointestinal surgery. This study investigated the effect of early postoperative enteral nutrition versus placebo on cell-mediated immunity with the Multitest(R) CMI and correlated the results to the clinical outcome and to the preoperative nutritional status. Methods: Sixty patients were randomized to receive either enteral nutrition or placebo. All patients were stratified in accordance with preoperative nutritional status. CMI tests were applied 2 days before surgery and days 1 and 5 postoperatively. All tests were applied and recorded by the same investigator. Results: No significant differences in the score were seen between the groups. Nine patients were malnourished. No significant difference was seen preoperatively with regard to nutritional status, but the malnourished patients had a lower median value on the 3rd postoperative day. In patients with complications the preoperative median CMI score was 17.0 mm (95 % confidence limits, 10.5-24 mm), and in patients without complications 9.5 mm (95 % confidence limits, 5.5-16 mm). This result is significant and unexpected. Ten patients were anergic preoperatively, and three of these developed complications (30 %). The overall complication rate was 27 of 60 (45 %). A change in immunologic status from responding preoperatively to anergy postoperatively was significantly associated with severe complications (P = 0.043). Conclusions: Early enteral nutrition does not influence the CMI score. Preoperative anergy was not related to increased mortality/morbidity, whereas the change in CMI response towards anergy was significant.