Sezai ÖZKAN, Merih GÖKBEN, Oral ÖNCÜL, Sibel POÇAN, Volkan ACAR, Murat ÖZSOY

Majör abdominal cerrahisinde standart ve immünonütrisyonun, nütrisyon ve immünoloji parametrelerine etkilerinin karşılaştırılması

Çalışmamızda, majör abdominal cerrahi uygulanan olgularda, standart ve immun nütrisyon ürünleriyle yapılan erken enteral beslenmenin; nütrisyonel ve immünolojik parametrelere ve klinik sonuçlara etkisini karşılaştırmayı amaçladık. Çalışmamıza alınan ASA II 60 olgu, rasgele 2 gruba ayrıldı. Grup Ve (n=30) izokalorik izonitrojenik standart enterai nütrisyon, Grup II'ye (n=30) arginin, RNA nükleotidleri Omega-3 ve omega-6 yağ asitleri içeren immünonütrisyon uygulandı. Çalışmaya dahil edilen olguların tümü preoperatif 5. ve 1. gün ile post-operatif 1. ve 5. günü nütrisyon ve immünoloji değerlendirmesine alındılar ve albumin, prealbümin, retinol bağlayıcı protein (RBP) ve transferrin düzeylerine bakıldı, immünolojik değerlendirme için; IL-2ROL, IL-6, IgG, IgM, CRP, total lenfosit, T ve B-lenfosit değerlerine bakıldı. Postoperatif l. günde, nütrisyon parametrelerinde 2 gruptu da düşme izlendi (p

Comparison of the effects of standart and immunonutrition on nutritional and immunological parameters undergoing major abdominal surgery

In that clinical study we aimed to investigate the effects of preoperative and early postoperative started standart and immunonutrient products on nutritional and immune parameters, and clinical outcome of the patients who underwent malign abdominal tumor operation. Sixty patients, ASA II, were randomly divided into 2 groups in our study. Group I patients received iso-caloric, isonitrogenic standart oral nutrition, whereas Group II patients received enteral immunutrition with arginin, RNA nucleotide and omega-3 and omega-6 fatty acids. Studies of immune function and evaluation of nutritional parameters were made for all patients on preoperative 5 and 1, on postoperative day 1 and 5. For nutritional evaluation albumin, prealbumin retinol binding protein (RBP) and transferrin levels were determined. For immunologic evaluation IL-2R$alpha$ IL-6 levels, and IgG, IgM, CRP, total lymphocytes, T-lymphocytes, B-lymphocytes were determined. In both groups nutritional parameters were significantly decreased on postoperative day 1 (p

PDF

___

1. Braga M, Viagnali A, Gianotti L, et al: Immune and nutri¬ tional effect of early enteral nutrition after major abdominal oper¬ ations. Eur J Surg 1996; 162:105-12. 2. Daly JM, Lieberman MD, Goldfine J, et al: Enteral nutrition with supplemental arginine, RNA and omega-3 fatty acids in patients after operation: immunologic, metabolic, an-i clinical outcome. Surgery 1992; 112:56-67. 3. Kemen M, Şenkal M, Homann HH, et al: Eüıly postopera¬ tive enteral nutrition with arginine, omega-3 fatty acids and ribonücleic acid-supplemented dirt versus placebo in cancer patients: An immunologic evaluation of impact. Crit Care Med 1995; 23:652-9. 4. Wyncoll D, Beale R: Immunologically enhanced enteral nutri¬ tion: current status. Curr Opin Crit Care 2001 ;7:128-32. 5. Gianotti L, Braga M, Fortis C, et al: A prospective random¬ ized clinical trial on preoperative feeding with arginine omega-3 fatty acid and enriched enteral diet: effect on host response and nutritional status. JPEN 1999; 23:314-20. 6. Braga M, Gianotti L, Nespoli L, et al: Nutritional approach in malnourished surgical patients: a prospective randomized study.Arch Surg 2002; 137:174-80. 7. Beale RJ, Bryg DJ, Bihari DJ: Immunonutrition in the criti¬ cally ill: a systematic review of clinical outcome. Crit Care Med 1999; 27:2799-805. 8. Braga M, Viagnali A, Gianotti L, et al: Benefits of early postoperative enteral feeding in cancer patients. Infusionther Transfusionmed 1995; 22:280-4. 9. Barbul A: Arginine and immune function. Nutrition 1990; 6:53-8. 10. Gianotti L, Alexander JW, Pyles T, et al: Arginine-supple- mented diets improve survival in gut-derived sepsis and peritoni¬ tis by modulating bacterial clearance: The role of nitric oxide. Ann Surg 1993; 217:644-54. 11. Fanslow WC, Kulkarni AD, Van Suren CT, et ah Effect of nucleotide restriction and supplementation on resistance to exper¬ imental murine candidiasis. JPEN 1988; 12:49-52. 12. Rudolph FB, Kulkarni AD, Fanslow WC, et ah Role of RNA as a dietary source of pyrimidines and purines in immune function. Nutrition 1990; 6:45-51. 13. Kensler AS, Swails WS, Driscoll DF, et al: Early feeding in postsurgical cancer patients. Fish oil structured lipid-based poly¬ meric formula versus a standard polymeric formula. Ann Surg 1996; 223:316-33. 14. Gianotti L, Alexander JW, Pyles T, et ah Dietary fat acids modulate host bactericidal response, microbial translocation and outcome following blood transfusion and thermal injury. Clin Nutr 1996; 15:291-6. : "' 15. Wigmore SJ, Fearon K, Ross J: Modulation of human hepa- tocyte acute phase protein production by omega-3 and omega-6 polyunsaturated fatty acids. Anri Surg 1997; 225:103-11. 16. Braga M, Gianotti L, Costantini E, et al: Impact of enteral nutrition on intestinal bacterial translocation and mortality in burned mice. Clin Nutr 1994; 13:256-61. 17. Senkal M, Mumme A, Elekhoff U, et al: Early postopera¬ tive enteral immunonutrition clinical outcome and cost-compari¬ son analysis in surgical patients. Crit Care Med 1997; 25:1489-96. 18. Senkal M, Zumtobel V, Bauer KH, et al: Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg 1999;134:1309-16. 19. Braga M, Gianotti L, Vignali A, Di Carlo V. Immunonutrition in gastric cancer surgical patients. Nutrition 1998;I4:831-5. 20. Şenkal M, Kemen M, Homann H, et al: Modulation of postoperative immune response by enteral nutrition with a diet enriched with arginine, RNA and omega-3 fatty acids in patients with upper gastrointestinal cancer. Eur J Surg 1995;161:115-22. 21. O'Flaherty L, Bouchier-Hayes DJ: Immunonutrition and surgical practice. Proc Nutr Soc 1999; 58:831-7. 22. Braga M, Gianotti L, Cestari A, et al: Gut function and immune and inflammatory responses in patients perioperatively fed with supplemented enteral formulas. Arch Surg 1996; 131:1257-65. 23. Gottschlich M, Jenkins M, Warden G, et.al: Differential effects of three enteral dietary regimens on selected outcome variables in burn patients. JPEN 1990; 14:225-36. 24. Daly JM, Weintraub F, Shou J, et al: Enteral nutrition dur¬ ing multimodality therapy in upper gastrointestinal cancer patients. Ann Surg 1995; 221:327-38. 25. Kudsk LA, Croce MA, Fabian TC, et al: Enteral versus parenteral feeding: effects on septic mortality after blunt and pen¬ etrating abdominal trauma Ann Surg 1992; 215:503-13. 26. Braga M, Gianotti L, Radaelli G, et »I: Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg 1999; 134:428-33.