Cosnes J, Lamy P, Beaugerie L, Le Quintrec M, Gendre J P, Le Quintrec Y
Service d'Hépatogastroentérologie, Hôpital Rothschild, Paris, France.
Gastroenterology. 1990 Dec;99(6):1814-9. doi: 10.1016/0016-5085(90)90492-j.
The specific nutritional consequences of malabsorption after small-bowel surgery were studied in a consecutive series of 48 ambulatory patients who had had small-bowel resection (n = 43) or bypass (n = 5) and in 10 patients who had an ileal pouch (n = 10). The patients received a 3-day standardized oral regimen providing daily 30 kcal/kg of ideal body weight (IBW). Throughout the study, 41 patients had malabsorption (fecal fat greater than 5%); 17 had fecal fat less than 5% and served as controls. The malabsorption patients absorbed 70% of protein and 71% of fat. Twenty-one were normonourished and 20 had features of mild energy malnutrition, vs. 15 and 2 controls, respectively. Compared with controls, malabsorption patients had decreased body weight and triceps skin-fold but no features of protein malnutrition. their mean daily food intake at home was significantly enhanced (39.6 +/- 13.1 kcal/IBW kg) vs. controls (28.8 +/- 5.8 kcal/IBW kg, P less than 0.001). In the malabsorption group, caloric intake was higher in the normonourished patients than in those with mild malnutrition. This study shows that a chronic malabsorption has limited nutritional consequences. The patients compensate for their absorptive handicap by increasing their oral intake.
对48例门诊患者进行了研究，这些患者连续接受了小肠切除术（n = 43）或小肠旁路手术（n = 5），另外还有10例有回肠袋的患者（n = 10），以探讨小肠手术后吸收不良的具体营养后果。患者接受了为期3天的标准化口服方案，每天提供30千卡/理想体重（IBW）。在整个研究过程中，41例患者存在吸收不良（粪便脂肪大于5%）；17例患者粪便脂肪小于5%，作为对照。吸收不良的患者吸收了70%的蛋白质和71%的脂肪。21例营养正常，20例有轻度能量营养不良特征，而对照组分别为15例和2例。与对照组相比，吸收不良的患者体重和肱三头肌皮褶厚度降低，但没有蛋白质营养不良的特征。他们在家中的平均每日食物摄入量显著增加（39.6±13.1千卡/IBW千克），而对照组为（28.8±5.8千卡/IBW千克，P<0.001）。在吸收不良组中，营养正常的患者热量摄入量高于轻度营养不良的患者。这项研究表明，慢性吸收不良的营养后果有限。患者通过增加口服摄入量来弥补吸收障碍。
