Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol

被引:121
作者
Soop, M
Carlson, GL
Hopkinson, J
Clarke, S
Thorell, A
Nygren, J
Ljungqvist, O
机构
[1] Ersta Hosp, Ctr Gastrointestinal Dis, SE-11691 Stockholm, Sweden
[2] Karolinska Univ Hosp, Karolinska Inst, Surg Sci Ctr, Huddinge, Sweden
[3] Univ Manchester, Hope Hosp, Injury Res Grp, Salford M6 8HD, Lancs, England
关键词
D O I
10.1002/bjs.4642
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The effects of immediate postoperative enteral nutrition on postoperative nitrogen balance and insulin resistance were studied in patients subjected to an enhanced-recovery protocol. Methods: Eighteen patients undergoing major colorectal surgery in an enhanced-recovery protocol were randomized to immediate postoperative enteral feeding for 4 days with either complete or hypocaloric nutrition. Nitrogen balance and changes in glucose kinetics, substrate utilization (indirect calorimetry) and insulin sensitivity (hyperinsulinaemic-euglycaemic clamp) were measured. Values are mean(s.e.m.). Results: Mean postoperative urinary nitrogen losses were low (10-7(1-0) versus 10.5(0.7) g per day for complete versus hypocaloric nutrition) and insulin resistance was insignificant (-20(7) versus - 27(11) per cent), with no difference between groups. Complete enteral feeding was given without hyperglycaemia (blood glucose concentration 5.8(0.4) versus 5.0(0.4) mmol/1) and resulted in nitrogen balance (+ 0.1(0-8) versus - 12.6(0.6) g nitrogen per day; P < 0.001). Conclusion: This enhanced-recovery protocol was associated with minimal postoperative insulin resistance and nitrogen losses after surgery. Immediate postoperative enteral nutrition was provided without hyperglycaernia and resulted in nitrogen balance.
引用
收藏
页码:1138 / 1145
页数:8
相关论文
共 33 条
[1]   Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J].
Anderson, ADG ;
McNaught, CE ;
MacFie, J ;
Tring, I ;
Barker, P ;
Mitchell, CJ .
BRITISH JOURNAL OF SURGERY, 2003, 90 (12) :1497-1504
[2]   EFFECT OF EPIDURAL ANALGESIA ON METABOLIC RESPONSE TO MAJOR UPPER ABDOMINAL-SURGERY [J].
ASOH, T ;
TSUJI, H ;
SHIRASAKA, C ;
TAKEUCHI, Y .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1983, 27 (03) :233-237
[3]   Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition [J].
Basse, L ;
Raskov, HH ;
Jakobsen, DH ;
Sonne, E ;
Billesbolle, P ;
Hendel, HW ;
Rosenberg, J ;
Kehlet, H .
BRITISH JOURNAL OF SURGERY, 2002, 89 (04) :446-453
[4]   Standardized perioperative care protocols and reduced length of stay after colon surgery [J].
Bradshaw, BGG ;
Liu, SS ;
Thirlby, RC .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 1998, 186 (05) :501-506
[5]   EPIDURAL ANALGESIA IMPROVES POSTOPERATIVE NITROGEN-BALANCE [J].
BRANDT, MR ;
FERNANDES, A ;
MORDHORST, R ;
KEHLET, H .
BRITISH MEDICAL JOURNAL, 1978, 1 (6120) :1106-1108
[6]   ASPECTS OF PROTEIN-METABOLISM AFTER ELECTIVE SURGERY IN PATIENTS RECEIVING CONSTANT NUTRITIONAL SUPPORT [J].
CARLI, F ;
WEBSTER, J ;
RAMACHANDRA, V ;
PEARSON, M ;
READ, M ;
FORD, GC ;
MCARTHUR, S ;
PREEDY, VR ;
HALLIDAY, D .
CLINICAL SCIENCE, 1990, 78 (06) :621-628
[7]  
Carli F, 1996, REGION ANESTH, V21, P430
[8]   EFFECT OF PEROPERATIVE NORMOTHERMIA ON POSTOPERATIVE PROTEIN-METABOLISM IN ELDERLY PATIENTS UNDERGOING HIP-ARTHROPLASTY [J].
CARLI, F ;
EMERY, PW ;
FREEMANTLE, CAJ .
BRITISH JOURNAL OF ANAESTHESIA, 1989, 63 (03) :276-282
[9]  
Carr CS, 1996, BRIT MED J, V312, P869, DOI 10.1136/bmj.312.7035.869
[10]   THE EFFECT OF PREOPERATIVE GLUCOSE LOADING ON POSTOPERATIVE NITROGEN-METABOLISM [J].
CROWE, PJ ;
DENNISON, A ;
ROYLE, GT .
BRITISH JOURNAL OF SURGERY, 1984, 71 (08) :635-637