Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch K W, Kemen M, Hiesmayr J M, Horbach T, Kuse E R, Vestweber K H
Klinik f. Allgemein- und Visceralchirurgie, Klinikum "St. Georg", Leipzig, Germany.
Clin Nutr. 2006 Apr;25(2):224-44. doi: 10.1016/j.clnu.2006.01.015. Epub 2006 May 15.
Enhanced recovery of patients after surgery ("ERAS") has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference. EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10-15% within 6 months, BMI<18.5 kg/m(2), Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction). Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
手术后患者的加速康复（“ERAS”）已成为围手术期管理的一个重要关注点。从代谢和营养的角度来看，围手术期护理的关键方面包括：通过口服营养补充剂（ONS）进行肠内营养（EN），必要时进行管饲（TF），在食物摄入不足的情况下提供增加或确保营养摄入的可能性。本指南旨在为外科患者使用ONS和TF提供循证建议。它由一个跨学科专家组按照官方认可的标准制定，并基于1980年以来的所有相关出版物。该指南在一次共识会议上进行了讨论并获得通过。即使在没有明显营养不良的患者中，如果预计患者围手术期将无法进食超过7天，也建议进行EN。对于无法维持口服摄入量超过推荐摄入量60%超过10天的患者也适用。在这些情况下，应立即开始营养支持。对于存在以下至少一项标准定义的严重营养风险的患者，建议推迟手术进行术前EN：6个月内体重减轻>10 - 15%，BMI<18.5 kg/m²，主观全面评定C级，血清白蛋白<30 g/l（无肝或肾功能障碍证据）。总之，强烈建议不要等到出现严重营养不良，一旦营养风险显现，应尽早开始EN治疗。
