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首页> 美国卫生研究院文献>Annals of Surgery >A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications.
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A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications.

机译：严重外伤后等氮肠内饮食的随机试验。增强免疫力的饮食可减少败血症并发症。

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OBJECTIVE: The authors randomized patients to an enteral diet containing glutamine, arginine, omega-3 fatty acids, and nucleotides or to an isonitrogenous, isocaloric diet to investigate the effect of septic outcome. A third group of patients, without enteral access but eligible by severity of injury, served as unfed controls and were studied prospectively to determine the risk of infection. SUMMARY BACKGROUND DATA: Laboratory and clinical studies suggest that diets containing specialty nutrients, such as arginine, glutamine, nucleotides, and omega-3 fatty acids, reduce septic complications. Unfortunately, most clinical trials have not compared these diets versus isonitrogenous, isocaloric controls. This prospective, blinded study randomized 35 severely injured patients with an Abdominal Trauma Index > or = 25 or a Injury Severity Score > or = 21 who had early enteral access to an immune-enhancing diet ([IED] Immun-Aid, McGaw, Inc., Irvine, CA; n = 17) or an isonitrogenous, isocaloric diet (Promote [Ross Laboratories, Columbus, OH] and Casec [Mead-Johnson Nutritionals, Evansville, IN]; n = 18) diet. Patients without early enteral access but eligible by severity of injury served as contemporaneous controls (n = 19). Patients were evaluated for septic complications, antibiotic usage, hospital and intensive care unit (ICU) stay, and hospital costs. RESULTS: Two patients died in the treatment group and were dropped from the study. Significantly fewer major infectious complications (6%) developed in patients randomized to the IED than patients in the isonitrogenous group (41%, p = 0.02) or the control group (58%, p = 0.002). Hospital stay, therapeutic antibiotics, and the development of intra-abdominal abscess was significantly lower in patients receiving the IED than the other two groups. This improved clinical outcome was reflected in reduced hospital costs. CONCLUSIONS: An IED significantly reduces major infectious complications in severely injured patients compared with those receiving isonitrogenous diet or no early enteral nutrition. An IED is the preferred diet for early enteral feeding after severe blunt and penetrating trauma in patients at risk of subsequent septic complications. Unfed patients have the highest complication rate.
机译：目的：作者将患者随机分为含有谷氨酰胺，精氨酸，ω-3脂肪酸和核苷酸的肠内饮食或等氮等温饮食，以研究败血症结果的影响。第三组无肠通路但符合损伤严重程度的患者作为未进食的对照，并进行了前瞻性研究以确定感染的风险。摘要背景数据：实验室和临床研究表明，含有精氨酸，谷氨酰胺，核苷酸和omega-3脂肪酸等特殊营养的饮食可减少败血症并发症。不幸的是，大多数临床试验都没有将这些饮食与等氮等温对照进行比较。这项前瞻性，盲目的研究将35例腹部创伤指数≥25或损伤严重度评分≥21的严重受伤患者随机分为两组，这些患者已通过肠内早期获得免疫增强饮食（[IED] Immun-Aid，McGaw，Inc例如，加州尔湾（Irvine）； n = 17）或等热量，等热量饮食（推广[Ross Laboratories，Columbus，OH]和Casec [Mead-Johnson Nutritionals，Evansville，IN]； n = 18）饮食。无早期肠进入但符合损伤严重程度的患者作为同期对照（n = 19）。对患者进行了败血病并发症，抗生素使用，住院和重症监护病房（ICU）住院以及医院费用的评估。结果：治疗组中有2例患者死亡，并退出研究。与等氮组（41％，p = 0.02）或对照组（58％，p = 0.002）相比，随机分配给IED的患者发生的主要感染并发症显着减少（6％）。接受IED的患者的住院时间，治疗性抗生素和腹腔内脓肿的发生率明显低于其他两组。临床结果的改善反映在医院成本的降低上。结论：与接受等氮饮食或不接受早期肠内营养的患者相比，IED可显着减少重伤患者的主要感染并发症。对于有后续脓毒性并发症风险的患者，IED是严重钝器和穿透性创伤后早期肠内喂养的首选饮食。未进食的患者并发症发生率最高。

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