Saint Mary's Hospital, Waterbury, CT 06706, USA.
Nutrients. 2013 Feb 21;5(2):608-23. doi: 10.3390/nu5020608.
Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient's outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7-10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations.
自 1936 年 Studley 证实术前体重减轻与手术死亡率之间存在直接关系以来，外科和危重症患者的营养支持已经取得了重大进展。全肠外营养的出现，加上肠内和肠外喂养的非凡进展，以及细胞生物学和生物化学知识的增加，使临床医生能够治疗营养不良并改善外科患者的结局。我们回顾了围手术期营养的文献，比较了肠外营养与肠内营养。对于已确诊营养不良的外科患者，营养支持应在手术前至少 7-10 天开始。对于那些预计术后 5 天内无法进食的患者，应根据肠道是否可以使用，早期给予肠内或肠外喂养。与肠外营养相比，肠内营养与较少的并发症相关，住院时间缩短，具有有利的成本效益分析。此外，许多患者可能受益于新型肠内配方，如免疫营养以及特定疾病的配方。
