Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica · 2016
[Early parenteral nutrition in complex post-operative periods].
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Molina Caballero A I, Pérez Martínez A, Hernández Martín S, González Temprano N, Ayuso González L, Pisón Chacón J
Аннотация
OBJECTIVE: The protein hypercatabolic state in critically ill pediatric patients can be minimized by an effective nutrition therapy. We conducted a study to evaluate the benefits of early parenteral nutrition (EPN) assessing its effect on nutritional parameters and clinical relevance after complex surgical procedures.
METHODS: Prospective randomized study in patients undergoing abdominal surgery in which nothing by mouth is anticipated for a period ≥ 3 days, between 2012 and 2014. Blood tests were performed assessing nutritional parameters in the first 24 hours and the 5th postoperative day. Two groups were created, starting EPN in group A and standard fluid therapy in group B, after the extraction of the first sample.
RESULTS: Forty-four patients were included, 18 in group A and 26 in group B. In the first analysis all had decreased levels of prealbumin and retinol-binding protein. On the 5th day, 55,6% of group A normalized prealbumin levels compared to 11,5% of B (p: 0.003, EF = 80%) whereas retinol-binding protein was normalized in 66,7% and 34.6%, respectively (p: 0,07, EF = 48,4%). Three patients in group A (16,7%) had postoperative infectious complications compared to 8 in B (30,8%), difference no statistically significant but clinically relevant (NNT=7,1), since the latter showed low prealbumin levels and longer hospital stay. No complications related to EPN were detected.
CONCLUSION: Administration of EPN in the complex postoperative patients appears to be safe and beneficial for their recovery, being the prealbumin an early indicator of good nutritional response.
METHODS: Prospective randomized study in patients undergoing abdominal surgery in which nothing by mouth is anticipated for a period ≥ 3 days, between 2012 and 2014. Blood tests were performed assessing nutritional parameters in the first 24 hours and the 5th postoperative day. Two groups were created, starting EPN in group A and standard fluid therapy in group B, after the extraction of the first sample.
RESULTS: Forty-four patients were included, 18 in group A and 26 in group B. In the first analysis all had decreased levels of prealbumin and retinol-binding protein. On the 5th day, 55,6% of group A normalized prealbumin levels compared to 11,5% of B (p: 0.003, EF = 80%) whereas retinol-binding protein was normalized in 66,7% and 34.6%, respectively (p: 0,07, EF = 48,4%). Three patients in group A (16,7%) had postoperative infectious complications compared to 8 in B (30,8%), difference no statistically significant but clinically relevant (NNT=7,1), since the latter showed low prealbumin levels and longer hospital stay. No complications related to EPN were detected.
CONCLUSION: Administration of EPN in the complex postoperative patients appears to be safe and beneficial for their recovery, being the prealbumin an early indicator of good nutritional response.