择期胃肠道手术患者的营养管理  

Perioperative nutritional management in electively gastrointestinal surgery

作　　者：陈宏[1] 李非[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京100053

出　　处：《中国普外基础与临床杂志》2017年第9期1150-1155,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结择期胃肠道手术患者的营养管理策略。方法对近年来有关择期胃肠道手术患者围手术期营养管理的研究进行综述,从术前营养评估、术后血糖控制、营养途径和免疫营养方面进行总结。结果目前术前的营养评价方法有人体测量、实验室检查、主观全面评价法(subjective global assessment,SGA)、营养风险筛查(nutritional risk screening,NRS)2002、Reilly营养风险筛查、营养风险指标(nutritional risk indicator,NRI)评分系统等,但目前还不能确定在准确预测术后并发症方面,哪项术前营养评估系统更具优势。近来实施的加速康复外科措施可明确减轻手术应激和胰岛素抵抗,从而减少术后并发症的发生和改善预后。此外,近年在营养不足患者围手术期应用肠内和肠外营养的指征方面也出台了相应临床指南,如中华医学会肠外肠内营养学分会发布的《成人围手术期营养支持指南》。在免疫营养方面,一些系统性回顾研究表明,免疫营养能够降低择期胃肠道大手术患者的并发症发生率,缩短住院时间。结论围手术期营养管理通过营养评估,保障患者从营养支持中获益,降低手术所导致的营养风险,减少代谢紊乱发生,实现手术患者的营养支持目标,最终减少术后并发症的发生。Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery. Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery, including four major directions： preoperative nutritional evaluation, glucose level control, nutritional type, and immunonutrition. Results At present, preoperative nutritional evaluation methods included anthropometry, laboratory tests, subjective global assessment （SGA）, nutritional risk screening （NRS） 2002, Reilly nutritional risk screening, nutritional risk indicator （NRI）, and so on. For preoperative nutritional assessment system, however, current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications. The usage of enhanced recovery after surgery （ERAS） protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes. There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients, who were defined in clinical guidelines recently, such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition （CSPEN）. Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery. Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment, can reduce the nutritional risk and metabolic disorder caused by operation, can achieve the goal of optimal nutrition support in surgical patients, and can ultimately reduce postoperative complications.

关 键 词：胃肠道手术 择期手术 营养管理 

分 类 号：R459.3[医药卫生—治疗学] R656[医药卫生—临床医学]