Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: A prospective, randomized, controlled, double-blind study
Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: A prospective, randomized, controlled, double-blind study
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DOI：
10.1016/j.clnu.2006.04.007
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发表时间：
2006-10-01
影响因子：
6.3
通讯作者：
Rowlands, Brian J.
中科院分区：
文献类型：
--
作者：
Lobo, Dileep N.;Williams, Robert N.;Rowlands, Brian J.
背景：大手术后提供围手术期免疫调节肠内喂养可能会减少感染并发症，但荟萃分析尚未证明具有生存优势。本研究的目的是确定术后早期免疫调节空肠造口喂养是否可以减少接受上消化道癌症切除手术的患者的感染并发症。方法：总共 120 名接受胰腺癌、食道癌和胃癌切除手术的患者以双盲方式随机接受免疫调节饮食的空肠造口喂养（Stresson 集团） A) 或等氮、等热量饲料（1250 卡路里和 75 克蛋白质/l-Nutrison 高蛋白 B 组）持续 10-15 天。术后4小时开始喂食，持续20小时/天。第 0 天的目标体积 (ml/h) 为 25，第 1 天为 50，此后为 75。结果指标包括并发症、住院时间和死亡率。结果：总共分析了 108 名患者（每组 54 名）。饲料输送虽然未达到目标，但两组的情况相似。每组有 6 人（11%）死亡。 A 组术后住院时间中位 (IQR) 为 14.5 (12-23) 天，B 组为 17.5 (13-23) 天 (P = 0.48)。每组共有 24 名患者（44%）出现感染并发症（P = 1.0）。 A 组共有 21 名患者（39%），B 组共有 28 名患者（52%）出现非感染性并发症（P = 0.18）。 A 组有 26 名患者（48%）发生空肠造口相关并发症，B 组有 30 名患者（56%）发生空肠造口相关并发症（P = 0.3）。结论：与标准喂养相比，术后早期喂养免疫调节饮食并没有带来结局优势。 (c) 2006 年爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background: The provision of perioperative immune modulating enteral feeds after major surgery may result in reduced infective complications, but meta-analyses have not demonstrated a survival advantage. The aim of this study was to determine whether early postoperative immune modulating jejunostomy feeding results in reduced infective complications in patients undergoing resectional surgery for upper gastrointestinal cancer.Methods: A total of 120 patients undergoing resection for cancers of the pancreas, oesophagus and stomach were randomized in a double-blind manner to receive jejunostomy feeding with an immune modulating diet (Stresson-Group A) or an isonitrogenous, isocaloric feed (1250 Calories and 75 g protein/l-Nutrison High Protein-Group B) for 10-15 days. Feeding was commenced 4 h postoperatively and continued for 20 h/day. The target volume (ml/h) was 25 on day 0, 50 on day 1, and 75 thereafter. Outcome measures included complications, hospital stay and mortality.Results: A total of 108 patients (54 in each group) were analysed. Feed delivery, although less than targeted, was similar in both groups. There were 6 (11%) deaths in each group. Median (IQR) postoperative hospital stay was 14.5 (12-23) days in Group A and 17.5 (13-23) days in Group B (P = 0.48). A total of 24 (44%) patients in each group had infective complications (P = 1.0). A total of 21 (39%) patients in Group A and 28 (52%) in Group B had non-infective complications (P = 0.18). Jejunostomy-related complications occurred in 26 (48%) patients in Group A and 30 (56%) in Group B (P = 0.3).Conclusion: Early postoperative feeding with an immune modulating diet conferred no outcome advantage when compared with a standard feed. (c) 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.