腹部外科围术期营养支持治疗的热点问题

Hot topics in the perioperative nutritional support therapy in abdominal surgery

营养不良在腹部外科较为常见,对患者的恢复产生影响,合理的营养支持治疗可改善患者预后.患者入院24 h内应行营养风险筛查,对于存在营养风险和营养不良的患者,需制订营养支持治疗计划,并选择合适的时机和途径行营养支持治疗.术前整夜禁食对绝大多数腹部外科患者是没有必要的,应允许摄入浓度很低的流质饮食至麻醉前2h.外科患者如术前存在重度营养不良,应行7∽10 d营养支持治疗.术后需要行营养支持治疗的患者,首选肠内营养支持治疗,但对肠内营养支持治疗不可行或达不到目标量的60％患者,应辅以肠外营养支持治疗.对于无严重伴发疾病的患者,通常没有必要行个体化营养支持治疗.ω-3多不饱和脂肪酸、谷氨酰胺等药理营养素对腹部外科大手术、危重患者有益,临床上可酌情使用.

Malnutrition is common in the abdominal surgery and affects the recovery of patients.Reasonable nutritional support therapy can improve the prognosis of patients.The nutritional risk screening should be apphed to patients within 24 hours of admission.Patients with the nutritional risk and malnutrition should receive the nutritional support by selecting a good timing and way based on the nutritional support planning.Preoperative fasting all night for the majority of patients is not necessary,patients should be allowed to intake low-concentration liquid diet at hour 2 before anesthesia.Patients with preoperative severe malnutrition should be given 7-10 days of nutritional support therapy.The enteral nutritional therapy was preferred to patients needing postoperative nutritional support therapy,while parenteral nutrition therapy should be supplied to patients with infeasible enteral nutrition or expected target of 60% for enteral nutrition.Individual nutritional support therapy is not necessary for patients without severe concomitant disease.Pharmacological nutrients such as ω-3 polyunsaturated fatty acids and glutamine are beneficial for abdominal surgery and critical patients,which should be used reasonably.