基于加速康复的代谢手术围手术期营养管理研究进展

Implementation of enhanced recovery after surgery in nutritional management of patients undergoing metabolic surgery

代谢手术是治疗肥胖及相关合并症的一种胃肠外科手术类型，近年来发展迅速。代谢手术患者术前即存在营养问题．该人群的营养管理是围手术期管理的重点。在围手术期，已有的研究充分应用ERAS理念，针对代谢手术人群的特点开展了相关探讨，初步证实了各项围手术期措施在临床实践中应用的安全性及有效性，包括：微量营养素的缺乏与补充，术前减重效果的探究，以及术前空腹及口服碳水化合物等。在术后饮食策略中，现有文献对营养管理的阶段界定及营养管理内容尚未统一，国内有关代谢手术围手术期营养管理的报道较少，且现有文献中营养管理实施的具体内容还存在分歧，尚缺乏统一、完善的参考标准，有必要形成规范的营养管理路径，为临床代谢手术围手术期营养管理的实施提供相关依据与参考。

Metabolic surgery is a gastrointestinal surgical procedure to treat obesity and its related eo- morbidities with rapid development in recent years. Patients undergoing metabolic surgery have preoperative nutritional disorders, and the nutrition management for these patients is the key point of perioperative management. During the perioperative period, current research has preliminarily confirmed that perioperative managements includingsupplementation of micronutrients, preoperative evaluation of the weight loss, preoperative fasting and carbohydrate oral intake based on the full application of ERAS and characteristics of the patients undergoing metabolic surgery, are safe and effective in clinical practice. As for the postoperative diet strategy, current literature remains non- unified to identify the duration and the content of the nutrition managements. Domestic clinical reports about the postoperative nutrition managements after metabolic surgery are rare and lack of unified and good reference standard. Meanwhile, divergence still existed in current literature regarding to the content of the postoperative nutrition managements. Therefore, it is necessary to develop the standardized protocol for nutrition managements which is offering basis and reference for the clinical application of perioperative nutrition managements after metabolic surgery.