Khatib-Chahidi K, Troja A, Kramer M, Klompmaker M, Raab H-R, Antolovic D
European Medical School, Universitätsklinik für Allgemein- und Viszeralchirurgie, Klinikum Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland,
Chirurg. 2014 Jun;85(6):520-8. doi: 10.1007/s00104-013-2637-2.
The incidence of malnutrition in oncological and visceral surgical units can be high. The screening of malnourished patients is very important, especially in the preoperative setting. The available published literature provides crucial knowledge about the risks inherent to malnutrition and subsequent perioperative morbidity and mortality. The preoperative screening of malnourished patients followed by a subsequent renutrition is the key to decreasing rates of postoperative morbidity and mortality. The data and guidelines given by the European Society of Parenteral and Enteral Nutrition (ESPEN) in 2006 for the preoperative nutritional conditioning are clear and give no doubt regarding the necessity of preparation of malnourished patients for elective abdominal surgery. Despite this fact, the observance and application of these guidelines among German surgical units remain low. To fill this void a model of systematic screening and treatment of malnutrition in the preoperative setting for elective abdominal surgery was created and implemented at the university hospital of Oldenburg. A practical treatment regimen was designed to prepare malnourished patients within 2-3 weeks before elective surgery. Initial results regarding the feasibility of preoperative home renutrition therapy were moderate but encouraging. The success of such a conditioning process depends on cooperation between the surgical unit, the general practitioner (GP) and the homecare environment. In the German healthcare system the prescription of home nutrition (i.e. enteral feeding) can lead to the prescription limits of a GP being exceeded and has to be justified to the medical insurance company in each case. This article presents a simple yet applicable way of screening and preparing malnourished patients a few weeks prior to elective surgery. Therefore, simple tools which can be promptly used in daily clinical life, especially in the outpatient surgical consultations prior to elective visceral surgery are proposed.
肿瘤外科和内脏外科病房中营养不良的发生率可能很高。对营养不良患者进行筛查非常重要，尤其是在术前阶段。现有的已发表文献提供了关于营养不良所固有的风险以及随后围手术期发病率和死亡率的关键知识。对营养不良患者进行术前筛查并随后进行营养再补充是降低术后发病率和死亡率的关键。欧洲肠外和肠内营养学会（ESPEN）在2006年给出的术前营养调节数据和指南很明确，对于择期腹部手术的营养不良患者进行准备的必要性毋庸置疑。尽管如此，德国外科病房对这些指南的遵守和应用程度仍然很低。为了填补这一空白，在奥尔登堡大学医院创建并实施了一种针对择期腹部手术术前阶段营养不良的系统筛查和治疗模式。设计了一种实用的治疗方案，以便在择期手术前2至3周内让营养不良患者做好准备。术前家庭营养再补充治疗可行性的初步结果尚可但令人鼓舞。这样一个调节过程的成功取决于外科病房、全科医生（GP）和家庭护理环境之间的合作。在德国医疗体系中，家庭营养（即肠内喂养）的处方可能会导致全科医生的处方限额被突破，并且每种情况都必须向医疗保险公司说明理由。本文介绍了一种在择期手术前几周对营养不良患者进行筛查和准备的简单且适用的方法。因此，提出了一些可在日常临床实践中迅速使用的简单工具，尤其是在择期内脏手术前的门诊外科会诊中。
