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Introduction : Previous studies have demonstrated that oxidative stress by mediating the excessive production of reactive oxygen species is involved in tissue damage and organ failure during and after... surgery. The impact of the preoperative immunonutrition including antioxidants on the postoperative course of patients undergoing hepatic surgery was investigated in this pilot study. Patients and Methods : Twenty-three living donor liver transplantation (LDLT) donors were randomly assigned to either an experimental (AO) group, received a commercial supplement enriched with antioxidant nutrients for each of the 5 days immediately prior to surgery while maintaining normal food intake, or a control (CT) group, administered no supplement. Antioxidative capacity was measured by spectrophotometry of patient serum using a free-radical analytical system. Results : The antioxidative capacity of 90.9% patients in the AO group increased after immunonutrition. Compared to the CT group, the AO group was found to have higher antioxidant capacity and transferrin levels ; lower WBC, lymphocyte, and neutrophil counts ; and briefer duration of postoperative fever during the postsurgical period. No significant differences were found between the 2 groups regarding the nutritional parameters ; liver functioning parameters ; immunological parameters ; intraoperative factors ; postoperative outcomes. Conclusion : Preoperative immunonutrition including antioxidants might play a beneficial role in improving postsurgical immunological response but the modest biological advantage was not associated with any significant clinical outcome.
【目的】活性酸素が過剰に産生されることで外科手術後に組織破壊や臓器機能不全を招来することがこれまで報告されている．本研究では肝切除を受ける患者に抗酸化物質を含む術前免疫栄養を行い，術後経過に与える効果を検討した．【対象と方法】23名の生体肝移植ドナーを対象とした．通常の食事に加え，術前5日間抗酸化物質を豊富に含む栄養剤を摂取した実験群(AO群)と通常の食事のみのコントロール群(CT群)に無作為に分けた．フリーラジカル自動分析装置を用いて患者血清を吸光光度分析法にて抗酸化力を測定した．【結果】AO群の90.9%において免疫栄養後に抗酸化力が増加した．CT群に比較してAO群は術後により高い抗酸化力とトランスフェリン値を示した．またAO群は術後の白血球数，好中球数が低く，術後発熱期間が短かった．それ以外の栄養学的指標，肝機能，免疫学的指標，手術因子や術後経過に2群間に差を認めなかった．【結論】抗酸化物質を含む術前免疫栄養による明らかな臨床的アウトカムを示せなかったが，術後免疫応答を改善するのに有用である可能性が示唆された．続きを見る
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