Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome.
Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome.
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发表时间：
1992-07
期刊：
影响因子：
3.8
通讯作者：
J. Daly;Lieberman;J. Goldfine;J. Shou;F. Weintraub;Rosato Ef;P. Lavin
中科院分区：
文献类型：
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作者：
J. Daly;Lieberman;J. Goldfine;J. Shou;F. Weintraub;Rosato Ef;P. Lavin
个别营养素精氨酸、RNA和omega-3脂肪酸改善免疫功能，但前瞻性试验尚未证明它们对临床结果的影响。85例因上消化道恶性肿瘤而接受手术的患者被随机分成两组，分别接受术后补充饮食或标准肠内饮食。两组患者的临床特征相似。两组之间的平均卡路里摄入量(1421大卡/天比1285大卡/天)相似。在前20名患者中测得的平均氮摄入量(15.6比9.0克/天)和氮平衡(-2.2比-6.6克/天)在补充组显著高于标准组(p=0.05)。在最初的31例患者中检测到了体外淋巴细胞有丝分裂，两组患者在术后第1天都有所下降，但只有补充组恢复到正常水平。在77名符合条件的患者队列中，补充组的感染和伤口并发症的发生率(11%比37%)明显低于标准组(p=0.02)。感染/伤口并发症的线性Logistic模型建议(p=0.10)饮食治疗是主要因素。补充组的平均住院时间(15.8+/-5.1天)明显短于标准组(20.2+/-9.4天)(P=0.01)。这些结果表明，术后补充精氨酸、RNA和omega-3脂肪酸的肠内营养替代标准的肠内饮食显著改善了接受重大择期手术的上消化道恶性肿瘤患者的免疫学、代谢和临床结果。
The individual nutrients arginine, RNA, and omega-3 fatty acids improve immune function, but prospective trials have not demonstrated their effects on clinical outcome. Patients (n = 85) who underwent operation for upper gastrointestinal malignancies were randomized to receive the supplemental diet or a standard enteral diet after surgery. Clinical patient characteristics were similar between the two groups. Mean caloric intakes (1421 vs 1285 kcal/day) were similar between groups. Mean nitrogen intakes (15.6 vs 9.0 gm/day) and nitrogen balances (-2.2 vs -6.6 gm/day) measured in the first 20 patients were significantly greater in the supplemented group than in the standard group (p = 0.05). In vitro lymphocyte mitogenesis was measured in the first 31 patients and was decreased on postoperative day 1 in both groups, but normal levels were regained only in the supplemented group. In the cohort of 77 eligible patients, infectious and wound complications occurred significantly less often (11% vs 37%) in the supplemented group than in the standard group (p = 0.02). Linear logistic models for infectious/wound complications with control for the amount of nitrogen suggested (p = 0.10) dietary treatment as the major factor. Mean length of stay in the hospital was significantly shorter (p = 0.01) for the supplemented group (15.8 +/- 5.1 days) than for the standard group (20.2 +/- 9.4 days). These results suggest that postoperative enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids instead of a standard enteral diet significantly improved immunologic, metabolic, and clinical outcomes in patients with upper gastrointestinal malignancies who were undergoing major elective surgery.