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Article(id=1322954148756455530, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322954116858782668, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202510016, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1760112000000, receivedDateStr=2025-10-11, revisedDate=1765296000000, revisedDateStr=2025-12-10, acceptedDate=null, acceptedDateStr=null, onlineDate=1793346448363, onlineDateStr=2026-10-30, pubDate=1767024000000, pubDateStr=2025-12-30, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793346448363, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793346448363, creator=13701087609, updateTime=1793346448363, updator=13701087609, issue=Issue{id=1322954116858782668, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='24', pageStart='3009', pageEnd='3159', issueExtLink='null', onlineDate='null', pubDate='1767024000000', pubDateStr='2025-12-30', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793346440757, creator='13701087609', updateTime=1793346440757, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=3089, endPage=3101, ext={EN=ArticleExt(id=1322954149108777067, articleId=1322954148756455530, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Impact of compound nutritional preparations on clinical prognosis of patients undergoing cardiovascular surgery: A randomized controlled study, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the effects of a compound nutritional preparation on postoperative wound healing, immune function, inflammatory response, nutritional status, and intestinal barrier function in patients after cardiovascular surgery, so as to provide a new nutritional intervention strategy for rapid recovery of trauma patients.

Methods

From September 2024 to January 2025, 65 eligible patients scheduled for open cardiovascular surgery at the Second Affiliated Hospital of Army Medical University were recruited, and randomly assigned via sealed envelopes to either an experimental group (n=32) or a control group (n=33). From the first day after operation, both groups received isocaloric and isonitrogenous enteral nutritional support for 7 d, and the control group was given a standard formula, while the experimental group took the compound nutritional preparation. Wound healing was assessed with REEDA scale on postoperative days 7 and 14. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC) count, C-reactive protein (CRP), TNF-α and IL-6 were measured preoperatively and on postoperative days 3 and 7. Immune function was evaluated by T-lymphocyte subsets (CD3+, CD4+, CD8+) and serum immunoglobulins (IgA, IgG, IgM). Nutritional status was assessed via serum albumin (ALB), prealbumin (PA), and total protein (TP). Intestinal barrier function was indicated by serum levels of diamine oxidase (DAO), lipopolysaccharide (LPS) and D-lactate. Body composition analysis was performed preoperatively and on postoperative day 7. Incidence of postoperative infectious complications and length of hospital stay were compared between the 2 groups.

Results

Finally, 60 patients completed the whole study, with 30 participants in each group. No significant differences were found in baseline indicators between the 2 groups. When compared with the control group, the experimental group exhibited significantly lower postoperative REEDA scores, reduced incidence of infectious complications, and shorter length of hospital stay (P<0.05), along with obviously higher skeletal muscle mass index (SMI) and 50 kHz whole-body phase angle (P<0.05). On postoperative day 3, there were no significant differences in above indicator between the 2 groups (P>0.05). On postoperative day 7, notably higher CD3⁺ and CD4⁺ T-cell counts and serum PA levels were observed in the experimental group than the control group (P<0.05). Significant group × time interactions were observed in CD3⁺, CD4⁺, and CD8⁺ T-cell counts and IgA level (P<0.05). Additionally, the experimental group had remarkably lower levels of NLR, CRP, TNF-α, IL-6, DAO, LPS, and D-lactate (P<0.05), with significant group×time interactions for NLR, CRP, IL-6, DAO, and D-lactate (P<0.05). There existed significant group×time interactions in NLR, CRP, IL-6, DAO, and D-lactate.

Conclusion

The compound nutritional preparation can promote wound healing, improve immune function and nutritional status, attenuate the inflammatory response, protect intestinal barrier function, and thereby facilitate postoperative recovery in patients undergoing open cardiovascular surgery.

, authors=Wenbin XIN1, Qian BAI1, Xiangmin NI1, Yong WANG2, Xinyu LIANG1, Mantian MI3, Jian WANG1, authorsList=Wenbin XIN, Qian BAI, Xiangmin NI, Yong WANG, Xinyu LIANG, Mantian MI, Jian WANG, authorCompany=null, correspAuthors=Mantian MI, Jian WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322954149842780270, articleId=1322954148756455530, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究, columnId=1320435175822050102, journalTitle=陆军军医大学学报, columnName=论著·临床医学, runingTitle=null, highlight=null, articleAbstract=
目的

评估复方营养制剂对心血管外科手术患者术后伤口愈合、免疫功能、炎症反应、营养状况及肠屏障功能的影响，为创伤患者快速康复提供新的营养干预策略。

方法

将2024年9月至2025年1月在陆军军医大学第二附属医院心血管外科拟行开放性手术治疗且符合标准的65例患者采用密封信封法随机分为试验组（n=32）和对照组（n=33）。术后第1天起，两组均接受7天等能量等蛋白肠内营养支持，对照组予常规配方，试验组予含复方营养制剂配方。于术后第7天和第14天采用REEDA评分法评估伤口愈合情况。术前、术后第3天和第7天检测中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、白细胞（white blood cells，WBC）、C-反应蛋白（C-reactive protein，CRP）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及白介素-6（interleukin-6，IL-6）以评估机体炎症反应及应激状况；检测T淋巴细胞（CD3+、CD4+、CD8+）及血清免疫球蛋白A（immunoglobulin A，IgA）、免疫球蛋白G（immunoglobulin G，IgG）、免疫球蛋白M（immunoglobulin M，IgM）以评估患者免疫功能；检测血清白蛋白（albumin，ALB）、前白蛋白（prealbumin，PA）、总蛋白（total protein，TP）以评估患者营养状况；检测血清二胺氧化酶（diamine oxidase，DAO）、内毒素（lipopolysaccharide，LPS）及D-乳酸以评估患者肠屏障功能；术前及术后第7天行体成分分析，定量评估患者脂肪、肌肉等组织成分的分布与比例；比较2组患者术后感染性并发症发生率及术后住院时间。

结果

最终60例完成研究（试验组和对照组各30例），2组基线资料差异均无统计学意义（P>0.05）。与对照组相比，试验组术后REEDA评分、术后感染性并发症发生率及住院时间显著降低（P<0.05），骨骼肌质量指数（skeletal muscle mass index，SMI）、50 kHz全身相位角显著升高（P<0.05）。术后第3天，各指标组间差异均无显著统计学意义（P>0.05）；术后第7天，试验组CD3+、CD4+T细胞计数及血清PA水平显著高于对照组（P<0.05），且CD3+、CD4+、CD8+ T细胞计数及IgA存在显著组别×时间交互效应（P<0.05）。试验组NLR、CRP、TNF-α、IL-6、DAO、LPS、D-乳酸显著低于对照组（P<0.05），且NLR、CRP、IL-6、DAO、D-乳酸存在显著的组别×时间交互效应（P<0.05）。

结论

该复方营养制剂能促进心血管外科开放性手术患者伤口愈合，改善免疫功能及营养状况，减轻炎症反应，保护肠屏障功能，促进患者术后康复。

, authors=辛文彬1, 白倩1, 倪向敏1, 王咏2, 梁馨予1, 糜漫天3, 王建1, authorsList=辛文彬, 白倩, 倪向敏, 王咏, 梁馨予, 糜漫天, 王建, authorCompany=null, correspAuthors=糜漫天, 王建, authorNote=null, correspAuthorsNote=
王建，E-mail：
糜漫天，E-mail：
WANG Jian，E-mail：
MI Mantian，E-mail：
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Cureus，2025，17（1）：e77521., articleTitle=Impact of preoperative sarcopenia on survival and postoperative outcomes in esophageal cancer patients undergoing esophagectomy：a single-center retrospective study, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322954150111215727, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, xref=1, ext=[AuthorCompanyExt(id=1322954150119604336, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150111215727, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Nutrition, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322954150127992945, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150111215727, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第二附属医院，营养科，重庆)]), AuthorCompany(id=1322954150228656242, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, xref=2, ext=[AuthorCompanyExt(id=1322954150346096755, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150228656242, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Cardiovascular Surgery，Second Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322954150358679668, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150228656242, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2陆军军医大学（第三军医大学）第二附属医院，心血管外科，重庆)]), AuthorCompany(id=1322954150434177141, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, xref=3, ext=[AuthorCompanyExt(id=1322954150442565750, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150434177141, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Department of Military Nutrition and Food Hygiene, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322954150450954359, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, companyId=1322954150434177141, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3陆军军医大学（第三军医大学）军事预防医学系营养与食品安全研究中心，重庆市医学营养研究中心，营养与健康重庆市重点实验室，重庆)])], figs=[ArticleFig(id=1322954155383455916, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=null, caption=null, figureFileSmall=9SbyXrjnqo5q8lpST9dN8A==, figureFileBig=HPLXvrGB7uAECMlek8feQA==, tableContent=null), ArticleFig(id=1322954157044400303, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=Figure 1, caption=Comparison of postoperative wound healing between the 2 groups, figureFileSmall=9SbyXrjnqo5q8lpST9dN8A==, figureFileBig=HPLXvrGB7uAECMlek8feQA==, tableContent=null), ArticleFig(id=1322954157216366768, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 1, caption=

Baseline demographic indicators，body composition and clinical characteristics of the participants ［n（%），M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/χ2/ZP
Sex0.0670.795
Male17（56.7）16（53.3）
Female13（43.3）14（46.7）
Age/years52.5（45.0，57.3）53.0（48.8，58.0）-0.5630.574
Fat mass/kg17.3（14.6，20.1）19.0（14.6，21.4）-0.4510.652
Skeletal muscle mass/kg27.8（21.3，31.7）24.0（20.2，28.2）-1.7230.085
BMI/（kg/m²）24.1 ± 2.624.5 ± 3.0-0.5410.591
Body fat percentage/%27.1 ± 7.628.7 ± 7.6-0.7740.442
Basal metabolic rate/kcal1 454.5（1 213.8，1 592.5）1 288.0（1 186.0，1 472.5）-1.6260.104
SMI/（kg/m2）7.3（6.3，8.2）7.0（6.0，7.9）-0.6360.524
50 kHz whole-body phase angle6.3 ± 0.86.0 ± 1.01.2790.206
SGA grade0.2780.598
A11（36.7）13（43.3）
B19（63.3）17（56.7）
C00
NRS 2002 score3.4 ± 0.63.3 ± 0.50.9360.354
NYHA class1.5580.756
Ⅰ2（6.7）1（3.3）
Ⅱ6（20.0）7（23.3）
Ⅲ19（63.3）21（70.0）
Ⅳ3（10）1（3.3）
Surgical procedure1.9980.397
Cardiac valve replacement24（80.0）27（90.0）
Aortic sinus aneurysm repair2（6.7）0（0.0）
Ascending aortic graft replacement4（13.3）3（10.0）
), ArticleFig(id=1322954157296058545, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表1, caption=

人口学、体成分指标和临床特征的基线情况 ［n（%），M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/χ2/ZP
Sex0.0670.795
Male17（56.7）16（53.3）
Female13（43.3）14（46.7）
Age/years52.5（45.0，57.3）53.0（48.8，58.0）-0.5630.574
Fat mass/kg17.3（14.6，20.1）19.0（14.6，21.4）-0.4510.652
Skeletal muscle mass/kg27.8（21.3，31.7）24.0（20.2，28.2）-1.7230.085
BMI/（kg/m²）24.1 ± 2.624.5 ± 3.0-0.5410.591
Body fat percentage/%27.1 ± 7.628.7 ± 7.6-0.7740.442
Basal metabolic rate/kcal1 454.5（1 213.8，1 592.5）1 288.0（1 186.0，1 472.5）-1.6260.104
SMI/（kg/m2）7.3（6.3，8.2）7.0（6.0，7.9）-0.6360.524
50 kHz whole-body phase angle6.3 ± 0.86.0 ± 1.01.2790.206
SGA grade0.2780.598
A11（36.7）13（43.3）
B19（63.3）17（56.7）
C00
NRS 2002 score3.4 ± 0.63.3 ± 0.50.9360.354
NYHA class1.5580.756
Ⅰ2（6.7）1（3.3）
Ⅱ6（20.0）7（23.3）
Ⅲ19（63.3）21（70.0）
Ⅳ3（10）1（3.3）
Surgical procedure1.9980.397
Cardiac valve replacement24（80.0）27（90.0）
Aortic sinus aneurysm repair2（6.7）0（0.0）
Ascending aortic graft replacement4（13.3）3（10.0）
), ArticleFig(id=1322954157375750322, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 2, caption=

Baseline laboratory indicators of the participants ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/ZP
NLR2.4±0.82.7±1.4-1.1560.253
WBC/（109/L）6.0±1.56.4±1.9-0.7620.449
ALB/（g/L）45.8±3.144.6±4.61.1830.242
PA/（g/L）278.8±63.2264.3±64.10.8780.384
TP/（g/L）72.6±6.171.6±6.90.6410.524
HGB/（g/L）139.8±17.0137.2±13.50.6460.521
CRP/（mg/L）3.0±1.12.8±1.30.3620.719
IgG/（g/L）13.8±3.713.9±2.8-0.2030.840
IgA/（g/L）2.3（1.6，3.0）2.3（1.9，3.0）-0.6360.525
IgM/（g/L）1.3（1.0，1.6）1.2（0.9，1.5）-0.8720.383
CD3+/（cells/μL）961.0（744.5，1 194.0）892.0（750.5，1 168.0）-0.0670.947
CD4+/（cells/μL）551.3±178.9522.5±168.10.6430.522
CD8+/（cells/μL）292.0（209.0，415.5）333.0（245.0，448.0）-0.2370.813
CD4+/CD8+1.6（1.3，2.8）1.6（1.0，2.0）-0.8000.424
TNF-α/（pg/mL）45.5（34.2，57.7）48.3（38.2，75.9）-1.4790.139
IL-6/（pg/mL）14.0（10.4，20.1）13.4（11.7，23.4）-0.4510.652
DAO/（ng/mL）2.8（1.8，3.5）2.8（2.1，4.3）-0.8130.416
LPS/（pg/mL）2 585.9±920.32 650.1±923.4-0.2700.789
D-lactate/（μmoL/mL）0.3（0.2，0.3）0.3（0.2，0.3）-1.0790.280
), ArticleFig(id=1322954157451247796, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表2, caption=

各项实验室指标的基线情况 ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/ZP
NLR2.4±0.82.7±1.4-1.1560.253
WBC/（109/L）6.0±1.56.4±1.9-0.7620.449
ALB/（g/L）45.8±3.144.6±4.61.1830.242
PA/（g/L）278.8±63.2264.3±64.10.8780.384
TP/（g/L）72.6±6.171.6±6.90.6410.524
HGB/（g/L）139.8±17.0137.2±13.50.6460.521
CRP/（mg/L）3.0±1.12.8±1.30.3620.719
IgG/（g/L）13.8±3.713.9±2.8-0.2030.840
IgA/（g/L）2.3（1.6，3.0）2.3（1.9，3.0）-0.6360.525
IgM/（g/L）1.3（1.0，1.6）1.2（0.9，1.5）-0.8720.383
CD3+/（cells/μL）961.0（744.5，1 194.0）892.0（750.5，1 168.0）-0.0670.947
CD4+/（cells/μL）551.3±178.9522.5±168.10.6430.522
CD8+/（cells/μL）292.0（209.0，415.5）333.0（245.0，448.0）-0.2370.813
CD4+/CD8+1.6（1.3，2.8）1.6（1.0，2.0）-0.8000.424
TNF-α/（pg/mL）45.5（34.2，57.7）48.3（38.2，75.9）-1.4790.139
IL-6/（pg/mL）14.0（10.4，20.1）13.4（11.7，23.4）-0.4510.652
DAO/（ng/mL）2.8（1.8，3.5）2.8（2.1，4.3）-0.8130.416
LPS/（pg/mL）2 585.9±920.32 650.1±923.4-0.2700.789
D-lactate/（μmoL/mL）0.3（0.2，0.3）0.3（0.2，0.3）-1.0790.280
), ArticleFig(id=1322954157514162357, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 3, caption=

Comparison of postoperative wound REEDA scores between 2 groups（ITT analysis）［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ImputationItemExperimental group（n = 33）Control group（n = 32）ZP
MeanD7 score2.0（1.5，2.6）2.0（2.0，3.8）-2.0410.037
D14 score1.0（0.0，1.1）1.0（1.0，2.0）-2.2780.002
WorstD7 score2.0（1.5，3.2）2.0（2.0，4.0）-1.9160.036
D14 score1.0（0.0，1.3）1.0（1.0，2.0）-2.2340.014
BestD7 score2.0（1.1，2.5）2.0（2.0，3.8）-2.3190.018
D14 score1.0（0.0，1.0）1.0（1.0，2.0）-2.6000.007
), ArticleFig(id=1322954157598048438, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表3, caption=

受试者术后伤口REEDA评分比较（ITT分析）［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ImputationItemExperimental group（n = 33）Control group（n = 32）ZP
MeanD7 score2.0（1.5，2.6）2.0（2.0，3.8）-2.0410.037
D14 score1.0（0.0，1.1）1.0（1.0，2.0）-2.2780.002
WorstD7 score2.0（1.5，3.2）2.0（2.0，4.0）-1.9160.036
D14 score1.0（0.0，1.3）1.0（1.0，2.0）-2.2340.014
BestD7 score2.0（1.1，2.5）2.0（2.0，3.8）-2.3190.018
D14 score1.0（0.0，1.0）1.0（1.0，2.0）-2.6000.007
), ArticleFig(id=1322954157673545911, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 4, caption=

Comparison of postoperative wound REEDA scores between groups（PP analysis）［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）ZP
D7 score2.0（1.0，3.0）2.0（2.0，4.0）-2.2100.027
D14 score1.0（0.0，1.0）1.0（1.0，2.0）-2.5360.011
), ArticleFig(id=1322954157736460472, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表4, caption=

受试者术后伤口REEDA评分比较（PP分析）［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）ZP
D7 score2.0（1.0，3.0）2.0（2.0，4.0）-2.2100.027
D14 score1.0（0.0，1.0）1.0（1.0，2.0）-2.5360.011
), ArticleFig(id=1322954157841318073, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 5, caption=

Comparison of immune function indices at different time points ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
IgG/（g/L）D39.1±2.29.0±1.90.1290.898
D710.6（8.7，12.9）10.9（8.9，12.4）-0.3920.695
IgA/（g/L）D31.9±0.81.9±0.70.1260.900
D72.3（1.7，3.1）2.1（1.9，3.1）-0.0440.965
IgM/（g/L）D30.9±0.30.8±0.21.3710.176
D71.3±0.41.3±0.50.4020.689
CD3+/（cells/μL）D3532.1±242.4531.3±280.00.0120.991
D7961.4±268.5722.6±299.93.2500.002
CD4+/（cells/μL）D3308.5（205.5，411.8）308.5（213.5，375.3）0.4740.637
D7628.0±170.6426.0±162.74.693<0.001
CD8+/（cells/μL）D3136.0（82.0，256.0）164.0（118.5，268.5）-0.4730.636
D7276.0（180.5，346.5）223.0（164.0，292.5）-1.5890.112
CD4+/CD8+D31.9（1.4，3.2）1.7（1.2，2.3）-0.7330.464
D72.2（1.7，3.3）1.8（1.3，2.6）-1.1470.251
), ArticleFig(id=1322954157921009850, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表5, caption=

不同时间点受试者免疫功能指标比较 ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
IgG/（g/L）D39.1±2.29.0±1.90.1290.898
D710.6（8.7，12.9）10.9（8.9，12.4）-0.3920.695
IgA/（g/L）D31.9±0.81.9±0.70.1260.900
D72.3（1.7，3.1）2.1（1.9，3.1）-0.0440.965
IgM/（g/L）D30.9±0.30.8±0.21.3710.176
D71.3±0.41.3±0.50.4020.689
CD3+/（cells/μL）D3532.1±242.4531.3±280.00.0120.991
D7961.4±268.5722.6±299.93.2500.002
CD4+/（cells/μL）D3308.5（205.5，411.8）308.5（213.5，375.3）0.4740.637
D7628.0±170.6426.0±162.74.693<0.001
CD8+/（cells/μL）D3136.0（82.0，256.0）164.0（118.5，268.5）-0.4730.636
D7276.0（180.5，346.5）223.0（164.0，292.5）-1.5890.112
CD4+/CD8+D31.9（1.4，3.2）1.7（1.2，2.3）-0.7330.464
D72.2（1.7，3.3）1.8（1.3，2.6）-1.1470.251
), ArticleFig(id=1322954158017478843, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 6, caption=

Estimated parameters from the GEE model for immune function indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
IgA/（g/L）Group × Time T30.2820.1370.014~0.5500.039
CD3+/（cells /μL）Group × Time T3274.00067.418141.863~406.137<0.001
CD4+/（cells /μL）Group × Time T3173.16737.98598.718~247.615<0.001
CD8+/（cells /μL）Group × Time T399.43336.81627.275~171.5920.007
), ArticleFig(id=1322954158092976316, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表6, caption=

免疫功能指标GEE模型参数估计结果

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
IgA/（g/L）Group × Time T30.2820.1370.014~0.5500.039
CD3+/（cells /μL）Group × Time T3274.00067.418141.863~406.137<0.001
CD4+/（cells /μL）Group × Time T3173.16737.98598.718~247.615<0.001
CD8+/（cells /μL）Group × Time T399.43336.81627.275~171.5920.007
), ArticleFig(id=1322954158176862397, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 7, caption=

Comparison of inflammation and stress indicators at different time points ［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n=30）Control group（n=30）ZP
NLRD39.8（7.2，14.7）9.3（6.7，12.7）-0.1920.848
D74.0（3.5，5.0）4.8（3.9，6.7）-2.5870.010
CRP/（mg/L）D3104.2（79.4，143.2）90.4（68.2，117.45）-1.2230.221
D719.9（14.4，30.1）32.5（17.5，56.0）-2.9350.003
WBC/（109/L）D311.6（9.0，14.0）11.5（9.4，14.3）-0.5690.569
D79.5（8.8，11.8）10.2（7.6，12.9）-0.6060.544
TNF-α/（pg/mL）D367.0（48.8，79.6）76.6（51.3，115.5）-1.5750.115
D746.6（37，62.9）63.3（40.2，79.7）-2.2550.024
IL-6/（pg/mL）D325.2（14.0，46.4）55.2（16.4，157.2）-1.5230.128
D712.9（6.4，37.5）43.2（13.6，96.0）-2.4540.014
), ArticleFig(id=1322954158243971262, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表7, caption=

不同时间点受试者炎症及应激指标比较 ［M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n=30）Control group（n=30）ZP
NLRD39.8（7.2，14.7）9.3（6.7，12.7）-0.1920.848
D74.0（3.5，5.0）4.8（3.9，6.7）-2.5870.010
CRP/（mg/L）D3104.2（79.4，143.2）90.4（68.2，117.45）-1.2230.221
D719.9（14.4，30.1）32.5（17.5，56.0）-2.9350.003
WBC/（109/L）D311.6（9.0，14.0）11.5（9.4，14.3）-0.5690.569
D79.5（8.8，11.8）10.2（7.6，12.9）-0.6060.544
TNF-α/（pg/mL）D367.0（48.8，79.6）76.6（51.3，115.5）-1.5750.115
D746.6（37，62.9）63.3（40.2，79.7）-2.2550.024
IL-6/（pg/mL）D325.2（14.0，46.4）55.2（16.4，157.2）-1.5230.128
D712.9（6.4，37.5）43.2（13.6，96.0）-2.4540.014
), ArticleFig(id=1322954158306885823, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 8, caption=

Estimated parameter from the GEE model for inflammation and stress indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
NLRGroup × Time T3-2.0660.825-3.684~-0.4480.012
CRP/（mg/L）Group × Time T3-18.7205.155-28.823~-8.617<0.001
IL-6/（pg/mL）Group × Time T3-78.65637.415-151.988~-5.3240.036
TNF-α/（pg/mL）Group-8.9314.535-17.821~-0.0420.049
), ArticleFig(id=1322954158373994688, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表8, caption=

炎症及应激指标GEE模型参数估计结果

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
NLRGroup × Time T3-2.0660.825-3.684~-0.4480.012
CRP/（mg/L）Group × Time T3-18.7205.155-28.823~-8.617<0.001
IL-6/（pg/mL）Group × Time T3-78.65637.415-151.988~-5.3240.036
TNF-α/（pg/mL）Group-8.9314.535-17.821~-0.0420.049
), ArticleFig(id=1322954158457880769, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 9, caption=

Comparison of nutritional status indicators at different time points ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
ALB/（g/L）D338.0±3.938.3±4.9-0.2250.823
D736.8±3.036.9±5.2-0.1530.879
PA/（g/L）D3153.0（142.0，182.0）144.0（124.0，164.0）-1.1680.243
D7237.1±50.4203.6±45.3-2.7090.009
TP/（g/L）D361.2±5.361.1±5.30.0580.954
D760.6（59.1，67.1）63.7（55.8，66.4）-0.0370.971
), ArticleFig(id=1322954158545961154, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表9, caption=

不同时间点受试者营养状况指标比较 ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
ALB/（g/L）D338.0±3.938.3±4.9-0.2250.823
D736.8±3.036.9±5.2-0.1530.879
PA/（g/L）D3153.0（142.0，182.0）144.0（124.0，164.0）-1.1680.243
D7237.1±50.4203.6±45.3-2.7090.009
TP/（g/L）D361.2±5.361.1±5.30.0580.954
D760.6（59.1，67.1）63.7（55.8，66.4）-0.0370.971
), ArticleFig(id=1322954158621458627, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 10, caption=

Comparison of intestinal barrier function indicators at different time points ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
DAO/（ng/mL）D34.0（3.1，5.4）4.6（3.1，7.7）-1.1830.237
D73.0±1.34.2±2.0-2.6890.010
LPS/（pg/mL）D34 701.1±1 313.75 507.5±2 139.8-1.7590.085
D72 682.1±776.83 194.6±952.0-2.2850.026
D-lactate /（μmoL/mL）D30.3±0.10.3±0.1-0.0400.968
D70.3（0.2，0.3）0.3（0.2，0.4）-2.0550.040
), ArticleFig(id=1322954158684373188, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表10, caption=

不同时间点受试者肠屏障功能指标比较 ［M（P25，P75），x¯ ± s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTimeExperimental group（n = 30）Control group（n = 30）t/ZP
DAO/（ng/mL）D34.0（3.1，5.4）4.6（3.1，7.7）-1.1830.237
D73.0±1.34.2±2.0-2.6890.010
LPS/（pg/mL）D34 701.1±1 313.75 507.5±2 139.8-1.7590.085
D72 682.1±776.83 194.6±952.0-2.2850.026
D-lactate /（μmoL/mL）D30.3±0.10.3±0.1-0.0400.968
D70.3（0.2，0.3）0.3（0.2，0.4）-2.0550.040
), ArticleFig(id=1322954158764064965, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 11, caption=

Estimated parameters from the GEE model for intestinal barrier function indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
DAO/（ng/mL）Group×Time T3-0.8980.367-1.617~-0.1780.015
D-lactate /（μmoL/mL）Group×Time T3-0.0680.029-0.124~-0.0120.018
), ArticleFig(id=1322954158860533958, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表11, caption=

肠屏障功能指标GEE模型参数估计结果

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemParameterβSE95%CIP
DAO/（ng/mL）Group×Time T3-0.8980.367-1.617~-0.1780.015
D-lactate /（μmoL/mL）Group×Time T3-0.0680.029-0.124~-0.0120.018
), ArticleFig(id=1322954158948614343, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=EN, label=Table 12, caption=

Comparison of body composition indicators among participants on postoperative day 7 ［M（P25，P75），x¯ ±s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/ZP
Fat mass/kg15.4（13.1，19.0）17.4（13.6，20.4）-0.4950.620
Skeletal muscle mass/kg25.5±5.123.0±4.91.9840.052
BMI/（kg/m²）22.7（21.7，24.1）23.5（21.6，25.4）-1.0950.274
Body fat percentage/%25.1（20.5，32.8）29.8（21.2，35.1）-0.7760.438
Basal metabolic rate/kcal1374.2±188.41300.7±179.61.5480.127
SMI/（kg/m2）7.0±0.86.5±0.92.3160.024
50 kHz whole-body phase angle5.9±0.85.2±1.12.7020.009
), ArticleFig(id=1322954159011528904, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954148756455530, language=CN, label=表12, caption=

术后第7天受试者人体成分指标比较 ［M（P25，P75），x¯ ±s］

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemExperimental group（n = 30）Control group（n = 30）t/ZP
Fat mass/kg15.4（13.1，19.0）17.4（13.6，20.4）-0.4950.620
Skeletal muscle mass/kg25.5±5.123.0±4.91.9840.052
BMI/（kg/m²）22.7（21.7，24.1）23.5（21.6，25.4）-1.0950.274
Body fat percentage/%25.1（20.5，32.8）29.8（21.2，35.1）-0.7760.438
Basal metabolic rate/kcal1374.2±188.41300.7±179.61.5480.127
SMI/（kg/m2）7.0±0.86.5±0.92.3160.024
50 kHz whole-body phase angle5.9±0.85.2±1.12.7020.009
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复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究
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辛文彬 1 , 白倩 1 , 倪向敏 1 , 王咏 2 , 梁馨予 1 , 糜漫天 3 , 王建 1
陆军军医大学学报 | 论著·临床医学 2025,47(24): 3089-3101
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陆军军医大学学报 |论著·临床医学 2025 , 47 (24) : 3089 -3101
复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究
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辛文彬1, 白倩1, 倪向敏1, 王咏2, 梁馨予1, 糜漫天3 , 王建1
作者信息
  • 1陆军军医大学（第三军医大学）第二附属医院，营养科，重庆
  • 2陆军军医大学（第三军医大学）第二附属医院，心血管外科，重庆
  • 3陆军军医大学（第三军医大学）军事预防医学系营养与食品安全研究中心，重庆市医学营养研究中心，营养与健康重庆市重点实验室，重庆
通讯作者:
王建，E-mail：
糜漫天，E-mail：
WANG Jian，E-mail：
MI Mantian，E-mail：
Impact of compound nutritional preparations on clinical prognosis of patients undergoing cardiovascular surgery: A randomized controlled study
Wenbin XIN1, Qian BAI1, Xiangmin NI1, Yong WANG2, Xinyu LIANG1, Mantian MI3 , Jian WANG1
Affiliations
  • 1Department of Nutrition, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China
  • 2Department of Cardiovascular Surgery，Second Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China
  • 3Department of Military Nutrition and Food Hygiene, Nutrition and Food Safety Research Center，Chongqing Medical Nutrition Research Center，Chongqing Key Laboratory of Nutrition and Health，Faculty of Military Preventive Medicine，Army Medical University （Third Military Medical University），Chongqing，China
出版时间: 2025-12-30 doi: 10.16016/j.2097-0927.202510016
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摘要
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目的

评估复方营养制剂对心血管外科手术患者术后伤口愈合、免疫功能、炎症反应、营养状况及肠屏障功能的影响，为创伤患者快速康复提供新的营养干预策略。

方法

将2024年9月至2025年1月在陆军军医大学第二附属医院心血管外科拟行开放性手术治疗且符合标准的65例患者采用密封信封法随机分为试验组（n=32）和对照组（n=33）。术后第1天起，两组均接受7天等能量等蛋白肠内营养支持，对照组予常规配方，试验组予含复方营养制剂配方。于术后第7天和第14天采用REEDA评分法评估伤口愈合情况。术前、术后第3天和第7天检测中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、白细胞（white blood cells，WBC）、C-反应蛋白（C-reactive protein，CRP）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及白介素-6（interleukin-6，IL-6）以评估机体炎症反应及应激状况；检测T淋巴细胞（CD3+、CD4+、CD8+）及血清免疫球蛋白A（immunoglobulin A，IgA）、免疫球蛋白G（immunoglobulin G，IgG）、免疫球蛋白M（immunoglobulin M，IgM）以评估患者免疫功能；检测血清白蛋白（albumin，ALB）、前白蛋白（prealbumin，PA）、总蛋白（total protein，TP）以评估患者营养状况；检测血清二胺氧化酶（diamine oxidase，DAO）、内毒素（lipopolysaccharide，LPS）及D-乳酸以评估患者肠屏障功能；术前及术后第7天行体成分分析，定量评估患者脂肪、肌肉等组织成分的分布与比例；比较2组患者术后感染性并发症发生率及术后住院时间。

结果

最终60例完成研究（试验组和对照组各30例），2组基线资料差异均无统计学意义（P>0.05）。与对照组相比，试验组术后REEDA评分、术后感染性并发症发生率及住院时间显著降低（P<0.05），骨骼肌质量指数（skeletal muscle mass index，SMI）、50 kHz全身相位角显著升高（P<0.05）。术后第3天，各指标组间差异均无显著统计学意义（P>0.05）；术后第7天，试验组CD3+、CD4+T细胞计数及血清PA水平显著高于对照组（P<0.05），且CD3+、CD4+、CD8+ T细胞计数及IgA存在显著组别×时间交互效应（P<0.05）。试验组NLR、CRP、TNF-α、IL-6、DAO、LPS、D-乳酸显著低于对照组（P<0.05），且NLR、CRP、IL-6、DAO、D-乳酸存在显著的组别×时间交互效应（P<0.05）。

结论

该复方营养制剂能促进心血管外科开放性手术患者伤口愈合，改善免疫功能及营养状况，减轻炎症反应，保护肠屏障功能，促进患者术后康复。

复方营养制剂  /  创伤  /  伤口愈合  /  营养状况  /  炎症反应  /  免疫功能  /  肠屏障功能
Objective

To evaluate the effects of a compound nutritional preparation on postoperative wound healing, immune function, inflammatory response, nutritional status, and intestinal barrier function in patients after cardiovascular surgery, so as to provide a new nutritional intervention strategy for rapid recovery of trauma patients.

Methods

From September 2024 to January 2025, 65 eligible patients scheduled for open cardiovascular surgery at the Second Affiliated Hospital of Army Medical University were recruited, and randomly assigned via sealed envelopes to either an experimental group (n=32) or a control group (n=33). From the first day after operation, both groups received isocaloric and isonitrogenous enteral nutritional support for 7 d, and the control group was given a standard formula, while the experimental group took the compound nutritional preparation. Wound healing was assessed with REEDA scale on postoperative days 7 and 14. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC) count, C-reactive protein (CRP), TNF-α and IL-6 were measured preoperatively and on postoperative days 3 and 7. Immune function was evaluated by T-lymphocyte subsets (CD3+, CD4+, CD8+) and serum immunoglobulins (IgA, IgG, IgM). Nutritional status was assessed via serum albumin (ALB), prealbumin (PA), and total protein (TP). Intestinal barrier function was indicated by serum levels of diamine oxidase (DAO), lipopolysaccharide (LPS) and D-lactate. Body composition analysis was performed preoperatively and on postoperative day 7. Incidence of postoperative infectious complications and length of hospital stay were compared between the 2 groups.

Results

Finally, 60 patients completed the whole study, with 30 participants in each group. No significant differences were found in baseline indicators between the 2 groups. When compared with the control group, the experimental group exhibited significantly lower postoperative REEDA scores, reduced incidence of infectious complications, and shorter length of hospital stay (P<0.05), along with obviously higher skeletal muscle mass index (SMI) and 50 kHz whole-body phase angle (P<0.05). On postoperative day 3, there were no significant differences in above indicator between the 2 groups (P>0.05). On postoperative day 7, notably higher CD3⁺ and CD4⁺ T-cell counts and serum PA levels were observed in the experimental group than the control group (P<0.05). Significant group × time interactions were observed in CD3⁺, CD4⁺, and CD8⁺ T-cell counts and IgA level (P<0.05). Additionally, the experimental group had remarkably lower levels of NLR, CRP, TNF-α, IL-6, DAO, LPS, and D-lactate (P<0.05), with significant group×time interactions for NLR, CRP, IL-6, DAO, and D-lactate (P<0.05). There existed significant group×time interactions in NLR, CRP, IL-6, DAO, and D-lactate.

Conclusion

The compound nutritional preparation can promote wound healing, improve immune function and nutritional status, attenuate the inflammatory response, protect intestinal barrier function, and thereby facilitate postoperative recovery in patients undergoing open cardiovascular surgery.

compound nutritional preparations  /  trauma  /  wound healing  /  nutritional status  /  inflammatory response  /  immune function  /  intestinal barrier function
辛文彬, 白倩, 倪向敏, 王咏, 梁馨予, 糜漫天, 王建. 复方营养制剂干预对心血管外科手术患者临床预后影响的随机对照研究. 陆军军医大学学报, 2025 , 47 (24) : 3089 -3101 . DOI: 10.16016/j.2097-0927.202510016
Wenbin XIN, Qian BAI, Xiangmin NI, Yong WANG, Xinyu LIANG, Mantian MI, Jian WANG. Impact of compound nutritional preparations on clinical prognosis of patients undergoing cardiovascular surgery: A randomized controlled study[J]. Journal of Army Medical University, 2025 , 47 (24) : 3089 -3101 . DOI: 10.16016/j.2097-0927.202510016
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手术创伤可引发局部组织损伤及全身性病理生理反应，导致免疫功能紊乱、炎症反应失衡及伤口愈合延迟［1］。以往研究表明，外科患者常出现不同程度的伤口愈合延迟，其中继发感染率高达15%~25%，显著影响手术治疗效果，增加医疗费用［2-3］。心血管外科开放性手术因需体外循环（cardiopulmonary bypass，CPB）支持，具有典型的“双重打击”特征：CPB能够触发中性粒细胞浸润及促炎细胞因子级联释放，诱导全身性炎症风暴［4］；缺血再灌注损伤产生过量活性氧（reactive oxygen species，ROS），加剧代谢紊乱与免疫抑制，显著增加术后感染及伤口延迟愈合的风险，影响患者的治疗效果及临床预后［5-7］。
围手术期营养支持对调控创伤反应至关重要，现代营养治疗不仅需要满足能量-蛋白质需求，更强调通过功能性营养素靶向调控创伤后炎症、氧化应激及免疫应答［8-9］。研究显示，在创伤修复中免疫营养素（如谷氨酰胺、精氨酸、Omega-3脂肪酸等）可以为组织修复提供能量，平衡调节免疫应答，促进机体炎症消退［10-12］。抗氧化微量营养素（如维生素A/C/E、锌、硒等）可分别通过调控细胞分化、促进胶原合成、减轻氧化损伤等机制在伤口愈合中发挥积极作用［13-17］。然而在实际临床应用中，单一营养素的干预作用有限，不同营养素间的协同效应机制仍需深入验证。既往研究提示，复合营养配方可能减轻心血管外科术后全身炎症反应，增强免疫反应，加快术后康复，但其对伤口愈合、免疫功能及肠屏障功能的综合影响尚缺乏系统评价［18］。本研究据此采用随机对照试验设计，探究一种新型复方营养制剂对心血管外科手术患者术后伤口愈合、炎症指标、免疫功能及肠屏障功能的影响，为加速康复外科精准营养干预在心血管外科的应用提供循证依据。
1　研究对象与方法
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1.1　研究对象
研究对象为2024年9月至2025年1月在陆军军医大学第二附属医院心血管外科拟行开放性手术治疗的患者。本研究经陆军军医大学第二附属医院医学伦理委员会批准（2024-研第185-03），研究遵循《赫尔辛基宣言》原则，所有患者入组前签署书面知情同意书。纳入标准：①年龄18~70岁；②行体外循环下开放性手术的住院患者；③术前营养状态正常或轻度营养不良［身体质量指数（body mass index，BMI）≥18.5 kg/m2，血清白蛋白（albumin，ALB）≥30 g/L，主观全面营养评估（subjective global assessment，SGA）评分等级为A级或B级］；④手术风险相对较低、可配合临床研究患者。排除标准：①糖尿病等严重代谢性疾病；②合并严重肝肾功能不全患者；③存在肠内营养支持的禁忌证；④已使用其他严重影响代谢或免疫的药物；⑤妊娠或哺乳期妇女；⑥既往接受过同一解剖部位任意手术；⑦其他研究人员认为会妨碍完成研究的可能情况。终止标准：①受试者依从性差，不能配合完成试验者；②受试者因个人原因不愿意继续临床研究，要求中途退出者；③受试者突发疾病，需要进一步诊治，不适宜继续试验的情形；④干预期间发生严重不良事件（如肠梗阻、过敏性休克等）。
1.2　样本量估算
本研究为前瞻性、随机对照临床试验。以术后第14天REEDA评分值估算样本量，本研究的样本量基于本研究前期预实验的结果进行估算，预实验数据显示，对照组术后第14天REEDA评分为（1.45±0.71）分，预计试验组REEDA评分可下降0.6分，设定双侧α=0.05，β = 0.20（把握度为80%），入组比例为1∶1，参考本中心既往临床试验失访率，本研究设定失访率为15%，根据样本量计算公式，计算得每组样本量为26例，共需52例。
1.3　分组
由于患者病情特殊性及营养制剂感官差异，本研究采用开放性标签设计。通过SPSS 26.0软件按1∶1比例生成随机分组序列，并采用密封信封法实施随机化分组，以实现分配隐藏。在整个过程中，研究人员及受试者均无法预知分组结果，所有结局评估由未参与分组的研究人员进行，且不知晓患者分组信息。
1.4　干预措施
在手术准备阶段，研究人员通过NRS-2002评分对患者进行营养风险筛查，采用SGA对患者术前营养状况进行评估。试验组和对照组患者在术后均接受常规临床治疗及术后常规伤口护理，根据患者情况进行围手术期个性化饮食指导，适量控制饱和脂肪酸、反式脂肪酸摄入。2组患者均遵循《加速康复外科围术期营养支持中国专家共识（2019）》［19］分阶段、逐步递增的饮食治疗原则。
本研究采用分阶段营养支持策略，术后患者目标能量摄入由25 kcal/（kg·d）逐步达到30 kcal/（kg·d），目标蛋白质摄入由1.2 g/（kg·d）逐步达到2.0 g/（kg·d）。在排除肠内营养支持禁忌征后，2组患者术后第1~7天根据患者情况通过不同喂养途径（管饲/口服）进行肠内营养干预，对照组接受标准的肠内营养支持，配方为整蛋白型全营养制剂（品牌：力存，能量密度1.0 kcal/mL）和短肽型全营养制剂（品牌：力存，能量密度1.0 kcal/mL）。试验组为含复方营养制剂［一种自制配方，由菁培（重庆）生物制药有限公司生产，富含谷氨酰胺、精氨酸、Omega-3脂肪酸、维生素A、维生素C、维生素E以及锌和硒］的肠内营养配方，该复方营养制剂每批经检测公司（华测）检测，确保其稳定性及关键营养成分批间差异符合要求。2组营养干预采用等能量（640 kcal/d）等蛋白（50 g/d）喂养策略；与对照组相比，试验组配方中目标营养素每日剂量增加量为：谷氨酰胺20 g（对照组未添加）、精氨酸9 g（对照组未添加）、Omega-3脂肪酸1 g（对照组未添加）、维生素A增加1 400 μg、维生素C增加480 mg、维生素E增加200 mg、锌增加30 mg，并且额外添加了硒100 μg（对照组未添加），其他常量营养素、维生素与矿物质在2组间基本接近。术后膳食方案由专业营养师制定，遵循“流质→半流质→软食”的阶梯过渡原则，强调优质蛋白与低脂饮食结构，患者饮食指导持续至术后第14天。
干预期间由临床医师及专业营养师对患者胃肠道情况及营养制剂摄入情况进行监控，每日记录实际摄入量，达标率≥90%视为依从。如果预计未来3天肠内营养（enteral nutrition，EN）摄入无法满足全天目标量的60%，应尽早联合应用肠外营养（parenteral nutrition，PN）补充不足部分，使2组能量及蛋白摄入达到全天目标需要量。
1.5　评价指标
主要评价指标：术后伤口愈合情况（REEDA评分值），在术后第7、14天进行评估。REEDA评分法是一种系统化评估伤口愈合情况的工具［20］，主要由五个关键评估维度组成：发红（redness）、水肿（edema）、瘀斑（ecchymosis）、分泌物（discharge）、分离（approximation）。该评分法用于评估外科术后伤口愈合情况，具有操作简便、可量化等优点。
次要评价指标：①免疫功能指标：术前、术后第3天和第7天由检验科通过流式细胞仪定量分析T细胞及其亚群的比例和绝对计数（CD3+、CD4+、CD8+、CD4+/CD8+），通过化学发光法检测血清免疫球蛋白A（immunoglobulin A，IgA）、免疫球蛋白G（immunoglobulin G，IgG）、免疫球蛋白M（immunoglobulin M，IgM）；②炎症及应激指标：术前、术后第3天和第7天由检验科使用全自动血细胞分析仪进行血常规检测（白细胞、淋巴细胞及中性粒细胞），通过免疫比浊法测定C反应蛋白（C-reactive protein，CRP），采用ELISA检测炎症因子肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）和白介素-6（interleukin-6，IL-6）；③肠黏膜屏障功能指标：术前、术后第3天和第7天采用ELISA检测血清二胺氧化酶（diamine oxidase，DAO）、血清内毒素（lipopolysaccharide，LPS），采用生化法检测D-乳酸血清浓度；④营养状况：术前、术后第3天和第7天由检验科使用全自动生化分析仪检测血清ALB、前白蛋白（prealbumin，PA）和总蛋白（total protein，TP）；⑤人体成分测定：术前及术后第7天采用人体成分分析仪（Inbody S10，韩国）进行测定。利用生物电阻抗原理测量患者全身、躯干及四肢的体成分数据，检测内容包括体脂量、骨骼肌量、BMI、体脂百分比（body fat percentage，BFP）、基础代谢率（basal metabolic rate，BMR）、骨骼肌质量指数（skeletal muscle mass index，SMI）、全身相位角；⑥患者术后感染性并发症发生率（术后感染性并发症例数/总病例数×100%）及住院时间。
1.6　统计学分析
使用SPSS 26.0统计软件进行基线数据分析及不同时间点两组间差异比较。通过Shapiro-Wilk检验评估数据正态性，符合正态分布的数据以x¯ ± s表示，非正态分布数据以M（P25，P75）表示；两组间差异比较时，正态分布连续变量采用独立样本t检验，非正态分布连续变量采用Mann-Whitney U非参数检验。分类变量用n（%）表示，分类变量的组间比较采用χ2检验或Fisher精确检验。通过R语言（4.4.1版本）构建广义估计方程（generalized estimating equations，GEE）模型进行重复测量数据分析，选用可交换工作相关结构，该结构假设个体内不同时间点的观测值具有相关性，调整性别、年龄等基线混杂因素后评估时间效应、组间效应及时间×组别交互效应。所有统计分析采用双侧检验，以P<0.05为差异具有统计学意义。
2　结果
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2.1　研究基本情况及受试者基线特征
共筛查90例患者，65例符合标准并采用密封信封法随机分组（试验组33例，对照组32例）。最终60例完成研究（试验组/对照组各30例）。2组患者术后对肠内营养的耐受性良好，仅9例出现轻微胃肠道反应（恶心2例、腹胀5例、腹泻2例），除2例因腹泻退出外均持续干预。
完成研究的60例患者，其中男性33人（55%），女性27人（45%），年龄为53.0（47.3，58.0）岁。SGA评估显示：24例患者营养状态正常，36例患者存在轻度营养不良；所有患者存在营养风险（NRS2002评分≥3分）。2组受试者在人口学特征、疾病严重程度（心功能分级）、营养状况（体成分指标、营养风险筛查、营养评估）、临床治疗类型（手术方式）等基线数据的差异均无统计学意义（P>0.05，表1）。其他实验室指标，包括炎症及应激指标、营养状况指标、免疫功能指标、肠屏障功能指标均在临床参考值正常范围内，且差异无统计学意义（P>0.05，表2）。综上，2组基线数据均衡。
2.2　2组伤口愈合情况
采用REEDA评分法对术后第7天和第14天伤口愈合情况进行评估。意向性（intention-to-treat，ITT）分析中，对缺失值（试验组缺失3例：2例腹泻，1例中途退出；对照组缺失2例：1例病情加重，1例中途退出）采用均值（同组内受试者评分均值）填补、最差值（同组内评分最高10人均值）填补、最优值（同组内评分最低10人均值）填补3种方法进行敏感性分析（表3）。结果显示，3种缺失值填补方法分析结果一致，在术后第7天和术后第14天，试验组REEDA评分显著低于对照组（P<0.05）。符合方案集（per-protocol，PP）分析中，仅纳入严格遵循研究方案并完成干预和随访的受试者进行分析。结果显示，术后第7天和术后第14天，试验组的REEDA评分显著低于对照组（P<0.05，表4），与ITT分析结果保持一致。上述结果表明添加复方营养制剂能有效加快患者术后伤口愈合速度，2组患者术后伤口愈合情况对比图见图1。
2.3　两组其他次要结局指标比较
2.3.1　免疫功能指标
两组患者术前及术后第3天各项免疫功能指标均无显著组间差异（P>0.05）。至术后第7天，试验组CD3+ T与CD4+ T细胞计数显著高于对照组（P<0.05），而CD8+ T细胞计数、CD4+/CD8+比值及血清免疫球蛋白（IgG、IgA、IgM）水平组间差异仍无统计学意义（P>0.05，表5）。GEE分析显示，术后第7天，CD3+ T细胞、CD4+ T细胞、CD8+ T细胞及血清IgA均存在显著的组别×时间交互效应（表6），表明试验组这些指标上升幅度更大，试验组干预效果好于对照组。所有指标在术后第3天均未观察到显著交互效应（P<0.05）。表明试验组上述指标随时间上升幅度大于对照组，提示复方营养制剂在术后第7天表现出明显的免疫调节效应，且该效应具有一定的时间依赖性。
2.3.2　炎症及应激指标
两组术前及术后第3天各炎症及应激指标均无显著组间差异（P>0.05）。术后第7天，试验组TNF-α、CRP、IL-6水平及中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）显著低于对照组（P<0.05），而白细胞（white blood cells，WBC）组间差异无统计学意义（P>0.05，表7）。GEE分析显示，术后第7天NLR、CRP及IL-6均存在显著的组别×时间交互效应（P<0.05，表8），表明试验组上述指标随时间下降更显著。TNF-α则显示显著的组别主效应（P=0.049），而交互效应不显著，因2组基线一致，提示干预措施对TNF-α具有持续降低作用。术后第3天所有指标均未见显著交互效应（P>0.05）。
2.3.3　营养状况
术后两组营养指标较术前显著下降。术前及术后第3天各指标组间差异无统计学意义（P>0.05）。至术后第7天，试验组PA水平显著高于对照组（P<0.05），而ALB及TP水平组间差异无统计学意义（P>0.05，表9）。GEE分析显示，时间是营养指标变化的主要影响变量，未见显著的组别×时间交互效应（P>0.05）。结果表明，营养干预可能有助于促进术后PA的恢复。
2.3.4　肠屏障功能
两组患者肠屏障功能指标在术前及术后第3天均无显著组间差异（P>0.05）。术后第7天，试验组DAO、LPS及D-乳酸水平显著低于对照组（P<0.05，表10）。GEE分析显示（表11），DAO和D-乳酸在术后第7天存在显著的组别×时间交互效应（P<0.05），表明试验组中这两项指标随时间下降更为明显。LPS虽随时间变化显著，但无显著的交互效应。结果提示，干预措施有助于改善术后肠屏障功能，尤其体现在DAO和D-乳酸的降低。
2.3.5　人体成分分析
术前两组人体成分指标比较无显著差异（P>0.05）。术后第7天，试验组SMI和50 kHz全身相位角显著高于对照组（P<0.05）。而体脂量、骨骼肌量、BMI、体脂百分比及基础代谢率组间差异均无统计学意义（P>0.05，表12）。结果表明复方营养制剂干预有助于促进术后相位角及骨骼肌质量指数的恢复。
2.3.6　术后感染性并发症和住院时间
试验组术后感染性并发症发生率显著低于对照组（P<0.05），其中试验组发生肺部感染2例，对照组发生肺部感染5例、菌血症1例及多重耐药菌感染2例。此外，试验组术后平均住院时间显著短于对照组［（13.5±2.4）vs（15.6±3.7）d，P<0.05］。结果表明，复方营养制剂干预可有效降低术后感染风险并缩短术后住院时间。
3　讨论
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心血管外科手术的创伤与体外循环应激，使患者术后处于高炎症、高代谢及继发性免疫抑制状态，且常伴有营养不良风险，严重影响伤口愈合与术后康复［21］。因此，实施科学、有针对性的营养支持至关重要。课题组前期动物实验结果表明，一种含免疫营养素（精氨酸、Omega-3脂肪酸、谷氨酰胺）和抗氧化微量营养素（维生素A/C/E、锌、硒）的复方营养制剂具有促进伤口愈合，改善营养状况，调节炎症与免疫的潜力［22］。本研究通过随机对照试验进一步验证其临床疗效。结果表明，该复方营养制剂可有效促进心血管外科手术患者术后伤口愈合，改善免疫功能及营养状况，减轻炎症反应，保护肠屏障功能，降低感染并发症发生率，缩短术后住院时间。
3.1　终点选择与对伤口愈合的核心作用
促进伤口愈合是术后营养支持的核心目标之一。本研究将伤口愈合情况设为主要终点，主要基于以下三点考量：其一，复方营养制剂中各营养素的核心生理功能与伤口愈合的病理生理过程高度契合，伤口愈合情况也能够最为直接与敏感地验证营养干预的生物学效力；其二，伤口愈合情况是连接营养干预与最终临床预后之间的关键中间环节，改善伤口愈合情况，能够有效降低感染风险，进而可能缩短住院时间；其三，本研究属于小样本研究，如果以感染性并发症发生率及住院时间为研究终点，很可能因事件数不足而导致假阴性结果。
为客观、量化地评估这一终点，本研究采用了REEDA（发红、水肿、瘀斑、分泌物、分离）评分法，相较于主观性较强的传统愈合等级划分，该伤口愈合评估工具能提供更系统、精细的量化评估，并有助于识别早期感染信号，更适用于手术切口的愈合监测［23］。评估结果显示，试验组术后第7天及第14天的伤口愈合情况均显著优于对照组，证实了该复方营养制剂促进伤口愈合的明确效果。此疗效得益于配方中多种营养成分在伤口愈合不同阶段的协同作用。在炎症阶段，Omega-3脂肪酸通过抑制NF-κB通路下调TNF-α、IL-6等促炎因子表达，谷氨酰胺则通过支持免疫细胞功能，共同为组织修复创造适宜的微环境；在增殖与重塑阶段，精氨酸作为合成胶原蛋白的前体，维生素C作为羟化酶辅因子，锌作为多种金属酶的必需成分，三者协同促进了胶原蛋白的合成与交联，加速了组织修复［24-25］。这与前人研究结论相吻合，例如CEREDA等［26］的研究发现，补充含精氨酸、锌和抗氧化剂的营养配方能增加早期伤口胶原蛋白形成。KJAER等［27］研究发现，补充谷氨酰胺、精氨酸、锌和维生素C的组合可以改善患者创面愈合。本研究结果进一步提示，针对心脏手术患者伤口愈合的复杂病理生理过程，这种多靶点、多机制的复方营养策略，可能比传统单一营养素干预产生更为显著的综合效应，也为开发针对性的围手术期营养支持方案提供了重要的理论依据。
3.2　对全身炎症与免疫功能的调节作用
心脏手术，尤其是体外循环过程，通过血液接触激活及缺血再灌注损伤，可触发强烈的全身炎症反应，并与后续的继发性免疫抑制形成恶性循环，显著增加感染风险［5，6，28］。本研究观察到，术后第3天，所有患者均呈现炎症高峰（NLR、WBC、CRP、TNF-α、IL-6升高），组间无差异。而至术后第7天，各炎症指标水平逐渐下降，试验组NLR、CRP及炎症因子TNF-α、IL-6水平显著低于对照组，且CRP与IL-6存在显著的组别×时间交互效应。这表明复方营养制剂并未在炎症峰值期强行抑制炎症反应，而是有效促进了炎症的适时消退。从机制上分析，这可能依赖于配方中多种成分的多靶点协同作用：Omega-3脂肪酸能够竞争性抑制花生四烯酸代谢，并通过抑制NF-κB信号通路，下调TNF-α、IL-6等关键炎症因子的转录与释放［29］；同时，维生素A、C、E作为经典的抗氧化剂，通过清除体内产生的大量活性氧，减轻了氧化应激对炎症通路的激活［30］。这种促进炎症及时消退的作用，对于打破前述恶性循环、减轻器官继发性损伤具有积极的临床意义。
手术创伤及随之而来的炎症反应，常导致以细胞免疫抑制为特征的免疫功能紊乱，进而增加术后感染风险［31-34］。本研究发现，术后第7天，试验组CD3+与CD4+ T细胞计数均显著高于对照组，一个值得深入分析的发现是，两组患者的T细胞计数基本处于临床正常参考范围内，但试验组维持相对更高的水平。这表明，该复方营养干预的主要作用可能在于优化和维持重大手术应激后的免疫储备与稳态，而非仅仅纠正“低下”状态。结合前述炎症水平的更快下降，这种更优的免疫细胞基础共同构成了一个有利于防御感染、促进修复的免疫内环境［35］。此免疫调节效应与复方制剂中的多种成分密切相关。配方中的谷氨酰胺、精氨酸及Omega-3脂肪酸可通过促进淋巴细胞活化、增殖及细胞因子分泌等作用发挥免疫调节作用［36］。此外，维生素A影响淋巴细胞功能与分化，维生素C支持多种免疫细胞的吞噬与趋化功能，而锌则是多种免疫相关酶的功能核心［37-39］。这些成分可能从多途径协同支持了术后细胞免疫功能。本研究中，两组患者的体液免疫指标（IgA、IgM、IgG）在各时间点均无显著差异，提示该复方制剂对术后细胞免疫功能的调节作用更为突出，也反映了其作用机制的特定性。但此结果也可能受样本量所限，需在未来研究中进一步验证。
3.3　对肠屏障功能与营养状况的改善作用
心血管外科手术中，CPB所致的肠道低灌注与缺血再灌注损伤，是破坏肠黏膜屏障完整性的主要诱因，可导致细菌及内毒素易位，进而引发或加重全身炎症反应综合征（Systemic inflammatory response syndrome，SIRS）［40］。为客观评估肠屏障功能，本研究检测了血清DAO、D-乳酸及LPS水平。DAO是反映肠黏膜细胞完整性的敏感指标，D-乳酸可评估肠道通透性，LPS水平则直接提示内毒素易位程度［41-42］。结果显示，术后第7天，试验组上述三项指标均显著低于对照组。这表明，复方营养制剂干预能有效减轻肠黏膜细胞损伤、降低肠道通透性、减少内毒素入血。这一保护效应源于配方中关键成分的多靶点协同作用，谷氨酰胺能直接促进肠黏膜修复并降低DAO释放［43］；Omega-3脂肪酸通过其抗炎作用（如抑制NF-κB通路）减轻肠屏障损伤［43］；锌则作为抗氧化酶的辅助因子，通过清除氧自由基来减轻氧化应激直接造成的黏膜损伤［44］。
重大手术应激后，患者常陷入急性营养消耗状态，且通常伴有肌肉质量和功能下降，肌肉功能下降影响术后活动和肺功能，增加患者并发症发生率并影响预后［45］。在整体营养评估方面，除传统营养评估指标（如ALB、PA和TP）外，同时引入了SMI和相位角这2个体成分指标。SMI直接反映肌肉储备，低SMI与不良预后密切相关，相位角则是反映营养状况和代谢活力的敏感指标［46］。本研究结果显示，术后第7天试验组PA水平、SMI及相位角显著高于对照组，表明该营养干预不仅能改善急性期的蛋白质合成，更有助于维持患者的肌肉质量与细胞功能完整性。
3.4　结论与展望
综上所述，该复方营养制剂能促进患者术后伤口愈合，减轻全身性炎症反应，增强免疫功能，改善肠屏障功能及营养状况，降低感染性并发症发生率及缩短术后住院时间，在心血管外科围术期营养治疗中具有较好的临床转化价值。然而，本研究仍存在一定局限性：①本研究为单中心研究，外部效度受限；②排除了糖尿病、肝肾功能不全等患者，研究结论不适用于这些未被覆盖的高危人群；③随访时间较短（至术后14天），缺乏对长期预后（如瘢痕形成、感染复发）的观察；④开放性标签设计可能引入评估偏倚。未来的研究应聚焦于多中心、大样本的长期随访研究，并探索实施盲法的可行性，进一步验证和拓展本研究的发现，推动围术期精准营养治疗的临床转化。

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2025年第47卷第24期
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doi: 10.16016/j.2097-0927.202510016
  • 接收时间：2025-10-11
  • 首发时间：2026-10-30
  • 出版时间：2025-12-30
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  • 收稿日期：2025-10-11
  • 修回日期：2025-12-10
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    1陆军军医大学（第三军医大学）第二附属医院，营养科，重庆
    2陆军军医大学（第三军医大学）第二附属医院，心血管外科，重庆
    3陆军军医大学（第三军医大学）军事预防医学系营养与食品安全研究中心，重庆市医学营养研究中心，营养与健康重庆市重点实验室，重庆

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糜漫天，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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