Nutritional approach in malnourished surgical patients - A prospective Randomized study
Nutritional approach in malnourished surgical patients - A prospective Randomized study
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DOI：
10.1001/archsurg.137.2.174
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发表时间：
2002-02-01
影响因子：
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通讯作者：
Di Carlo, V
中科院分区：
文献类型：
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作者：
Braga, M;Gianotti, L;Di Carlo, V
假设：围手术期补充肠内配方奶粉可降低术后发病率。设计：随机临床试验。设置：一所大学医院的外科。患者：196名登记的营养不良患者（体重减轻大于或等于10%）的胃肠道恶性肿瘤的主要择期手术的候选人。干预：随机分组后（n= 150），一组在术后12小时内接受标准饮食的术后肠内喂养（对照组; n = 50）。另一组连续7天口服1 L/d富含精氨酸、ω-3脂肪酸和RNA的流质饮食（术前组; n = 50）。手术后，患者给予与对照组相同的标准肠内配方。第三组连续7天口服1 L/d的强化流质饮食。手术后，患者给予肠内喂养与相同的丰富的公式（围手术期组; n = 50）。主要结果措施：术后并发症和住院时间。结果：3组基线人口统计学，生化标志物，合并症因素和手术变量是可比的。意向治疗分析显示，对照组发生并发症的患者总数为24例，术前组为14例，围手术期组为9例（P= 0.02，对照组vs围手术期组）。术前（13.2天）和围手术期（12.0天）组的术后住院时间明显短于对照组（15.3天）（P = 0.01和P = 0.001，分别与对照组相比）。结论：围手术期免疫营养似乎是支持营养不良的癌症患者的最佳方法。
Hypothesis: Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity.Design: Randomized clinical trial.Setting: Department of surgery at a university hospital.Patients: One hundred ninety-six registered malnourished patients (weight loss greater than or equal to 10%) who were candidates for major elective surgery for malignancy of the gastrointestinal tract.Intervention: After randomization (n= 150), one group received postoperative enteral feeding with a standard diet within 12 hours of surgery (control group; n = 50). Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine, omega-3 fatty acids, and RNA (preoperative group; n = 50). After surgery, patients were given the same standard enteral formula as the control group. A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet. After surgery, patients were given enteral feeding with the same enriched formula (perioperative group; n = 50).Main Outcome Measures: Postoperative complications and length of hospital stay.Results: The 3 groups were comparable for baseline demographics, biochemical markers, comorbidity factors, and surgical variables. The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group, 14 in the preoperative group, and 9 in the perioperative group (P=.02, control group vs perioperative group). Postoperative length of stay was significantly shorter in the preoperative (13.2 days) and perioperative (12.0 days) groups than in the control group (15.3 days) (P =.01 and P =.001, respectively, vs the control group).Conclusion: Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer.