Maessen J M C, Hoff C, Jottard K, Kessels A G H, Bremers A J, Havenga K, Oostenbroek R J, von Meyenfeldt M F, Dejong C H C
Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Clin Nutr. 2009 Feb;28(1):29-33. doi: 10.1016/j.clnu.2008.10.014. Epub 2008 Dec 6.
BACKGROUND & AIMS: It was shown that patients in the Netherlands remain exposed to unnecessarily prolonged starvation after abdominal surgery. The present study examined whether a structured collaborative effort would help to implement the early start of oral nutrition after colorectal surgery.
In 2006, twenty-six Dutch hospitals signed up to a "breakthrough project" concerning the implementation of the enhanced recovery after surgery (ERAS) programme with early oral feeding as one of the key elements. Each hospital determined the usual start of food intake by analyzing 50 patients who underwent a colorectal resection in 2004 (n=1126). Subsequently, over the course of one year 861 colorectal surgery patients were treated according to the ERAS programme. The first day that patients were eating before and after the breakthrough project was compared using Kaplan-Meier analyses and Cox regression models.
Patients treated according to the ERAS programme were eating 3 days earlier than the patients traditionally treated (p<0.000). Two days after surgery 65% of the ERAS patients were eating normal food versus 7% of the pre-ERAS patients.
The present nationwide collaborative effort was successful in implementing a change towards an early start of oral nutrition after abdominal surgery.
研究表明，荷兰的患者在腹部手术后仍面临不必要的长时间饥饿。本研究旨在探讨系统性协作是否有助于在结直肠手术后尽早开始口服营养。
2006年，26家荷兰医院参与了一项“突破性项目”，该项目涉及实施术后加速康复（ERAS）计划，早期口服喂养是其中的关键要素之一。每家医院通过分析2004年接受结直肠切除术的50例患者（n = 1126）来确定通常的进食开始时间。随后，在一年的时间里，861例结直肠手术患者按照ERAS计划接受治疗。使用Kaplan-Meier分析和Cox回归模型比较了突破性项目前后患者开始进食的第一天。
按照ERAS计划治疗的患者比传统治疗的患者提前3天开始进食（p < 0.000）。术后两天，65%的ERAS患者开始正常饮食，而ERAS前的患者这一比例为7%。
目前的全国性协作成功实现了腹部手术后尽早开始口服营养的转变。
