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Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the Multitest CMI.

Abstract：

BACKGROUND:Patients who become anergic after surgery have a very high death rate, mainly due to infectious complications. It has earlier been shown that preoperative skin testing has predictive value for the clinical outcome in gastrointestinal surgery. This study investigated the effect of early postoperative enteral nutrition versus placebo on cell-mediated immunity with the Multitest CMI and correlated the results to the clinical outcome and to the preoperative nutritional status. METHODS:Sixty patients were randomized to receive either enteral nutrition or placebo. All patients were stratified in accordance with preoperative nutritional status. CMI tests were applied 2 days before surgery and days 1 and 5 postoperatively. All tests were applied and recorded by the same investigator. RESULTS:No significant differences in the score were seen between the groups. Nine patients were malnourished. No significant difference was seen preoperatively with regard to nutritional status, but the malnourished patients had a lower median value on the 3rd postoperative day. In patients with complications the preoperative median CMI score was 17.0 mm (95% confidence limits, 10.5-24 mm), and in patients without complications 9.5 mm (95% confidence limits, 5.5-16 mm). This result is significant and unexpected. Ten patients were anergic preoperatively, and three of these developed complications (30%). The overall complication rate was 27 of 60 (45%). A change in immunologic status from responding preoperatively to anergy postoperatively was significantly associated with severe complications (P = 0.043). CONCLUSIONS:Early enteral nutrition does not influence the CMI score. Preoperative anergy was not related to increased mortality/morbidity, whereas the change in CMI response towards anergy was significant.

journal_name

Scand J Gastroenterol

journal_title

Scandinavian journal of gastroenterology

authors

Beier-Holgersen R,Brandstrup B

doi

10.1080/00365529950172907

subject

Has Abstract

pub_date

1999-01-01 00:00:00

pages

98-102

issue

eissn

0036-5521

issn

1502-7708

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the Multitest CMI.