Early Enteral Nutrition with Prebiotic Fiber Supply in Major Abdominal Surgery versus Conventional Enteral Nutrition: A Prospective Controlled Trial_West China Medical Journal

Authors：

PENG Junwen

Department of Surgery, the Health Care Hospital for Women and Children of Renshou City, Renshou 620500, P. R. China;

Corresponding author：

Keywords：

益生元; 膳食纤维; 肠道菌群; 腹部外科

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【摘要】　目的　探讨强化益生元膳食纤维的肠内营养在腹部外科术后患者中的临床应用。　方法　 2008年7月-2010年11月30例接受腹部外科中等以上手术的患者术前随机分为研究组和对照组，每组15例。研究组患者于术后接受肠内营养，并予以强化益生元膳食纤维；对照组只接受相同的肠内营养支持。观察指标为术后感染并发症、胃肠道并发症、住院时间、抗生素治疗时间、C反应蛋白水平和病死率等。　结果　研究组术后住院时间为（10±5） d，对照组为（15±7） d，两组差异有统计学意义（t=2.251，P=0.033）；研究组C反应蛋白水平为（6.6±3.2） mg/L，对照组为（9.8±2.1） mg/L，两组差异有统计学意义（t=3.238，P=0.003）；研究组抗生素治疗时间为（5.0±3.5） d，对照组为（6.0±4.8） d，两组差异无统计学意义（t=0.652，P=0.520）。两组均无死亡病例；术后研究组2例发生感染并发症，对照组3例，两组感染并发症发生率差异无统计学意义（P=1.000）。两组患者均能耐受经肠内补充营养素。　结论　与常规肠内营养比较，给予强化益生元膳食纤维的肠内营养能减少腹部外科术后患者的住院时间，降低急性期炎症反应。
【Abstract】　Objective　 To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. 　Methods　 Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity.　Results　 Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, P lt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, P lt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, P gt;0.05). No patients died in both the two groups.　Conclusion　 Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.

Citation： PENG Junwen. Early Enteral Nutrition with Prebiotic Fiber Supply in Major Abdominal Surgery versus Conventional Enteral Nutrition: A Prospective Controlled Trial. West China Medical Journal, 2011, 26(9): 1327-1330. doi: Copy

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10.	张明鸣, 程惊秋, 翟宏军, 等. 添加特需营养素的营养支持对外科创伤后肠黏膜形态和屏障功能影响的实验研究[J]. 中华胃肠外科杂志, 2009, 12(3): 306-309.
11.	Rafter J, Bennett M, Caderni G, et al. Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients[J]. Am J Clin Nutr, 2007, 85(2): 488-496.
12.	Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy[J]. Langenbecks Arch Surg, 2005,390(2): 104-113.
13.	Rayes N, Seehofer D, Theruvath T, et al. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial[J]. Ann Surg, 2007, 246(1):36-41.
14.	Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[J]. Gut, 2004, 53(2): 241-245.
15.	McClave SA, Heyland DK, Wischmeyer PE. Comment on: probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[J]. JPEN,2009, 33(4):444-446.
16.	Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy[J]. Pediatrics,2005, 115(1):178-181.
17.	Tuohy KM, Rouzaud GC, BruckWM, et al. Modulation of the human gut microflora towards improved health using prebiotics - assessment of efficacy[J]. Curr Pharm Des, 2005,11(1):75-90.
18.	Langlands SJ, Hopkins MJ, Coleman N, et al. Prebiotic carbohydrates modify the mucosa associated microflora of the human large bowel[J]. Gut, 2004, 53(11): 1610-1616.
19.	Zhang MM, Cheng JQ, Lu YR, et al. Use of pre-, pro- and synbiotics in patients with acute pancreatitis: A meta-analysis [J]. World J Gastroenterol, 2010, 16(31): 3970-3978.

1. 　Deitch EA. Bacterial translocation or lymphatic drainage of toxic products from the gut: what is important in human beings? [J]. Surgery, 2002, 131(3): 241-244.
2. 　Langlands SJ, Hopkins MJ, Coleman N, et al. Prebiotic carbohydrates modify the mucosa associated microflora of the human large bowel[J]. Gut, 2004, 53(11): 1610-1616.
3. 　de Vrese M, Schrezenmeir J. Probiotics, prebiotics, and synbiotics[J]. Adv Biochem Eng Biotechnol, 2008, 111: 1-66.
4. 　Rayes N, Seehofer D, Theruvath T, et al. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial[J]. Ann Surg, 2007, 246(1): 36-41.
5. 　Reddy BS, MacFie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectom [J]. Br J Surg, 2007, 94(5): 546-554.
6. 　Olah A, Belagyi T, Issekutz A, et al. Randomized clinical trial of specific Lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis[J]. Br J Surg, 2002, 89(9): 1103-1107.
7. 　Besselink MGH, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2008, 371(9613): 651-659.
8. 　MacFie J. Current status of bacterial translocation as a cause of surgical sepsis[J]. Br Med Bull, 2004, 71: 1-11.
9. 　Murono K, Hirano Y, Koyano S, et al. Molecular comparison of bacterial isolates from blood with strains colonizing pharynx and intestine in immunocompromised patients with sepsis[J]. J Med Microbiol, 2003, 52(6): 527-530.
10. 　张明鸣, 程惊秋, 翟宏军, 等. 添加特需营养素的营养支持对外科创伤后肠黏膜形态和屏障功能影响的实验研究[J]. 中华胃肠外科杂志, 2009, 12(3): 306-309.
11. 　Rafter J, Bennett M, Caderni G, et al. Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients[J]. Am J Clin Nutr, 2007, 85(2): 488-496.
12. 　Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy[J]. Langenbecks Arch Surg, 2005,390(2): 104-113.
13. 　Rayes N, Seehofer D, Theruvath T, et al. Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial[J]. Ann Surg, 2007, 246(1):36-41.
14. 　Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[J]. Gut, 2004, 53(2): 241-245.
15. 　McClave SA, Heyland DK, Wischmeyer PE. Comment on: probiotic prophylaxis in predicted severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[J]. JPEN,2009, 33(4):444-446.
16. 　Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy[J]. Pediatrics,2005, 115(1):178-181.
17. 　Tuohy KM, Rouzaud GC, BruckWM, et al. Modulation of the human gut microflora towards improved health using prebiotics - assessment of efficacy[J]. Curr Pharm Des, 2005,11(1):75-90.
18. 　Langlands SJ, Hopkins MJ, Coleman N, et al. Prebiotic carbohydrates modify the mucosa associated microflora of the human large bowel[J]. Gut, 2004, 53(11): 1610-1616.
19. 　Zhang MM, Cheng JQ, Lu YR, et al. Use of pre-, pro- and synbiotics in patients with acute pancreatitis: A meta-analysis [J]. World J Gastroenterol, 2010, 16(31): 3970-3978.

West China Medical Journal

Early Enteral Nutrition with Prebiotic Fiber Supply in Major Abdominal Surgery versus Conventional Enteral Nutrition: A Prospective Controlled Trial

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