PDF(Pubmed)
Abstract：
UNASSIGNED: Early oral feeding after major abdominal surgery has been clearly shown to be safe and not a risk factor for anastomotic dehiscence. Within the Enhanced Recovery after Surgery protocol, it is the nutritional plan A. Nonetheless, one must consider that postoperative protein and energy requirements will often be not covered by oral food intake alone. Because nutritional status has been shown to be a prognostic factor in patients undergoing major abdominal surgery, the preoperative identification of patients at risk may be mandatory. Malnutrition may be underestimated in an overweight society. With special regard to patients with cancer and those with preexisting malnutrition, an accumulating caloric gap may be harmful in the early and late postoperative periods. Furthermore, complications requiring reoperation and intensive care treatment may occur.
UNASSIGNED: Therefore, a plan B for postoperative nutrition therapy is needed, using preferentially the enteral route. The European Society for Clinical Nutrition and Metabolism recently addressed perioperative nutritional management and the indications for enteral and even parenteral supplementation to achieve caloric requirements in the postoperative course. In the first months after surgery, persisting weight loss is common in patients with upper gastrointestinal resections, even in those with an uncomplicated course. This may delay the initiation of adjuvant chemotherapy, increase toxicity, and worsen long-term outcomes.
UNASSIGNED: Therefore, a plan B for postoperative nutrition therapy is needed, using preferentially the enteral route. The European Society for Clinical Nutrition and Metabolism recently addressed perioperative nutritional management and the indications for enteral and even parenteral supplementation to achieve caloric requirements in the postoperative course. In the first months after surgery, persisting weight loss is common in patients with upper gastrointestinal resections, even in those with an uncomplicated course. This may delay the initiation of adjuvant chemotherapy, increase toxicity, and worsen long-term outcomes.
摘要：
■腹部大手术后早期经口喂养已被明确证明是安全的，不是吻合口裂开的危险因素。在手术后增强恢复方案中，这是营养计划A，尽管如此，人们必须考虑到，术后蛋白质和能量需求往往不能单独通过口服食物摄入来满足。因为营养状况已被证明是腹部大手术患者的预后因素，术前识别有风险的患者可能是强制性的.在超重的社会中，营养不良可能被低估了。特别是癌症患者和先前存在营养不良的患者，累积的热量差距在术后早期和晚期可能是有害的。此外，可能发生需要再次手术和重症监护治疗的并发症。
■因此，需要进行术后营养治疗的B计划，优先使用肠内途径。欧洲临床营养与代谢学会最近讨论了围手术期营养管理以及肠内甚至肠胃外补充以在术后过程中达到热量需求的适应症。手术后的头几个月，持续的体重减轻在上消化道切除患者中很常见，即使在那些不复杂的过程中。这可能会延迟辅助化疗的开始，增加毒性，并恶化长期结果。
■因此，需要进行术后营养治疗的B计划，优先使用肠内途径。欧洲临床营养与代谢学会最近讨论了围手术期营养管理以及肠内甚至肠胃外补充以在术后过程中达到热量需求的适应症。手术后的头几个月，持续的体重减轻在上消化道切除患者中很常见，即使在那些不复杂的过程中。这可能会延迟辅助化疗的开始，增加毒性，并恶化长期结果。
