Shikora S A, Blackburn G L
Nutrition/Metabolism Laboratory, New England Deaconess Hospital.
Surg Clin North Am. 1991 Jun;71(3):509-21. doi: 10.1016/s0039-6109(16)45430-7.
Advances in major gastrointestinal surgery and the existence of a significant number of high-risk patients necessitate a detailed knowledge of the metabolic response to surgery and the need for adjunctive nutritional therapy. Such surgery has the potential to cause significant nutritional consequences affecting patient outcome. Often, patients present malnourished preoperatively because of their chronic gastrointestinal disease, advanced age, or comorbidity. Still others are at great risk for developing malnutrition postoperatively secondary to the hypercatabolism of prolonged illness or postoperative complications. In addition, the surgical alterations of the gastrointestinal tract might disrupt normal function sufficiently to result in chronic nutritional deficiencies. Because starvation is no longer an acceptable condition, these concerns need to be recognized prior to surgery, and if indicated, nutritional support must be initiated preoperatively. Placement of feeding jejunostomy catheters for early enteral support should be considered for all high-risk patients. Equally important, surgeons should maintain a watch for future nutritional innovations that will improve their ability to meet patients' nutritional requirements.
胃肠大手术的进展以及大量高危患者的存在，使得详细了解手术的代谢反应以及辅助营养治疗的必要性成为必然。此类手术有可能导致影响患者预后的重大营养后果。通常，患者术前因慢性胃肠疾病、高龄或合并症而存在营养不良。还有一些患者术后因长期疾病的高分解代谢或术后并发症而极易发生营养不良。此外，胃肠道的手术改变可能会充分扰乱正常功能，从而导致慢性营养缺乏。由于饥饿已不再是可接受的状况，这些问题在手术前就需要得到认识，并且如果有指征，必须在术前开始营养支持。对于所有高危患者，应考虑放置空肠造口喂养导管以进行早期肠内支持。同样重要的是，外科医生应关注未来的营养创新，这些创新将提高他们满足患者营养需求的能力。
