Unità Operativa Cardiologia Riabilitativa, IRCCS "Santa Maria Nascente" Fondazione Don C. Gnocchi, Milan, Italy.
JPEN J Parenter Enteral Nutr. 2010 Mar-Apr;34(2):143-50. doi: 10.1177/0148607109357627.
Nutrition support is an important aspect of multidisciplinary approaches in cardiology rehabilitation. However, little is known about the impact of a patient's nutrition status on recovery after elective heart surgery. The authors assessed changes in nutrition markers in patients undergoing postsurgical rehabilitation, and tested their correlation with systemic inflammatory responses and clinical outcomes to determine the adequacy of the prescribed dietary regimen.
Plasma concentrations of nutrition biomarkers were measured in 50 nondiabetic patients upon admission to a cardiology rehabilitation unit after coronary artery bypass grafting or mitral and/or aortic valve replacement (D0), and again 16 days later (D16).
On D16, low plasma albumin increased, anemia improved, and high levels of inflammation markers declined. Vitamins remained stable within normal values, with the exception of vitamin B12, which decreased significantly from 516 +/- 341 to 445 +/- 212 ng/mL (P = .007). Blood glucose was >110 mg/dL in 51% of the patients at baseline; this proportion did not decline after rehabilitation. Overweight patients (body mass index >25 kg/m(2)) were prevalent (58%). They showed a slightly but not significantly greater inflammatory response and had a higher incidence of infective complications than the normal-weight group, but similar levels of nutrition markers.
The standard dietary regimen followed during cardiological rehabilitation after major cardiovascular surgery aids recovery from surgical insult, but fails to normalize high glucose levels. Vitamin B12 supplementation should be encouraged because of its substantial reduction during the rehabilitation period.
营养支持是心脏病康复多学科方法的一个重要方面。然而，对于患者的营养状况对择期心脏手术后恢复的影响知之甚少。作者评估了接受术后康复的患者的营养标志物的变化，并测试了它们与全身炎症反应和临床结果的相关性，以确定规定的饮食方案是否足够。
在冠状动脉旁路移植术或二尖瓣和/或主动脉瓣置换术后，50 名非糖尿病患者在进入心脏病康复病房时（D0）和 16 天后（D16）测量血浆营养生物标志物浓度。
在 D16 时，低血浆白蛋白增加，贫血改善，高炎症标志物水平下降。除维生素 B12 外，维生素在正常值范围内保持稳定，其从 516±341ng/mL 显著下降至 445±212ng/mL（P=.007）。基线时 51%的患者血糖>110mg/dL；康复后这一比例没有下降。超重患者（体重指数>25kg/m2）很常见（58%）。与正常体重组相比，他们的炎症反应略高但无统计学意义，感染性并发症的发生率更高，但营养标志物水平相似。
在重大心血管手术后进行心脏病康复期间遵循的标准饮食方案有助于从手术创伤中恢复，但未能使高血糖水平正常化。由于在康复期间其大量减少，应鼓励补充维生素 B12。
