• 仁壽縣婦幼保健院外科（四川仁壽，620500）;

【摘要】　目的　 探討強(qiáng)化益生元膳食纖維的腸內(nèi)營(yíng)養(yǎng)在腹部外科術(shù)后患者中的臨床應(yīng)用。　方法　 2008年7月-2010年11月30例接受腹部外科中等以上手術(shù)的患者術(shù)前隨機(jī)分為研究組和對(duì)照組，每組15例。研究組患者于術(shù)后接受腸內(nèi)營(yíng)養(yǎng)，并予以強(qiáng)化益生元膳食纖維；對(duì)照組只接受相同的腸內(nèi)營(yíng)養(yǎng)支持。觀察指標(biāo)為術(shù)后感染并發(fā)癥、胃腸道并發(fā)癥、住院時(shí)間、抗生素治療時(shí)間、C反應(yīng)蛋白水平和病死率等。　結(jié)果　 研究組術(shù)后住院時(shí)間為（10±5） d，對(duì)照組為（15±7） d，兩組差異有統(tǒng)計(jì)學(xué)意義（t=2.251，P=0.033）；研究組C反應(yīng)蛋白水平為（6.6±3.2） mg/L，對(duì)照組為（9.8±2.1） mg/L，兩組差異有統(tǒng)計(jì)學(xué)意義（t=3.238，P=0.003）；研究組抗生素治療時(shí)間為（5.0±3.5） d，對(duì)照組為（6.0±4.8） d，兩組差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.652，P=0.520）。兩組均無(wú)死亡病例；術(shù)后研究組2例發(fā)生感染并發(fā)癥，對(duì)照組3例，兩組感染并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義（P=1.000）。兩組患者均能耐受經(jīng)腸內(nèi)補(bǔ)充營(yíng)養(yǎng)素。　結(jié)論　 與常規(guī)腸內(nèi)營(yíng)養(yǎng)比較，給予強(qiáng)化益生元膳食纖維的腸內(nèi)營(yíng)養(yǎng)能減少腹部外科術(shù)后患者的住院時(shí)間，降低急性期炎癥反應(yīng)。
【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.

引用本文： 彭俊文. 含益生元膳食纖維的早期腸內(nèi)營(yíng)養(yǎng)用于腹部外科術(shù)后的隨機(jī)對(duì)照研究. 華西醫(yī)學(xué), 2011, 26(9): 1327-1330. doi: 復(fù)制

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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.
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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. 　張明鳴, 程驚秋, 翟宏軍, 等. 添加特需營(yíng)養(yǎng)素的營(yíng)養(yǎng)支持對(duì)外科創(chuàng)傷后腸黏膜形態(tài)和屏障功能影響的實(shí)驗(yàn)研究[J]. 中華胃腸外科雜志, 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. 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. 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. 3. 　de Vrese M, Schrezenmeir J. Probiotics, prebiotics, and synbiotics[J]. Adv Biochem Eng Biotechnol, 2008, 111: 1-66.
  4. 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. 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. 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. 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. 8. 　MacFie J. Current status of bacterial translocation as a cause of surgical sepsis[J]. Br Med Bull, 2004, 71: 1-11.
  9. 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. 10. 　張明鳴, 程驚秋, 翟宏軍, 等. 添加特需營(yíng)養(yǎng)素的營(yíng)養(yǎng)支持對(duì)外科創(chuàng)傷后腸黏膜形態(tài)和屏障功能影響的實(shí)驗(yàn)研究[J]. 中華胃腸外科雜志, 2009, 12(3): 306-309.
  11. 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. 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. 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. 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. 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. 16. 　Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy[J]. Pediatrics,2005, 115(1):178-181.
  17. 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. 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. 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.