Meguid M M, Mughal M M, Debonis D, Meguid V, Terz J J
Surg Clin North Am. 1986 Dec;66(6):1167-76. doi: 10.1016/s0039-6109(16)44080-6.
The influence of nutritional status on the resumption of adequate food intake in 101 patients recovering from colorectal cancer operation was examined. Two thirds of these patients were well-nourished; the others were malnourished. Malnutrition criteria were serum albumin of less than 3.5 gm per dl plus any two of the following four factors: recent weight loss greater than 10 per cent or weight for height, mid-arm circumference, and triceps skinfold thickness lower than the tenth percentile. Over half of the well-nourished patients were eating 60 per cent or greater of their caloric requirements by the tenth postoperative day, whereas only one quarter of the malnourished patients had attained this intake. the morbidity and mortality in 33 malnourished patients was 52 and 12 per cent, respectively, compared with 31 and 6 per cent (p less than 0.01) in 68 nourished patients. The duration of postoperative functional starvation in malnourished patients without complications increased to an average of 22 days following a complication and was further prolonged after a complication. Age or operative procedure (curative or palliative) did not influence complication rate. Our data suggest that postoperative nutritional support as either TPN or enteral feeding using an elemental diet is indicated in malnourished patients and in well-nourished patients immediately following a complication requiring therapeutic intervention.
研究了营养状况对101例结直肠癌手术后恢复正常食物摄入量的影响。这些患者中有三分之二营养状况良好；其余患者营养不良。营养不良的标准为血清白蛋白低于每分升3.5克，再加上以下四个因素中的任意两个：近期体重减轻超过10%或身高体重、上臂中部周长和三头肌皮褶厚度低于第十百分位数。超过一半的营养良好的患者在术后第10天摄入的热量达到或超过其热量需求的60%，而只有四分之一的营养不良患者达到了这一摄入量。33例营养不良患者的发病率和死亡率分别为52%和12%，而68例营养良好患者的发病率和死亡率分别为31%和6%（p<0.01）。无并发症的营养不良患者术后功能性饥饿的持续时间在出现并发症后平均增加到22天，出现并发症后进一步延长。年龄或手术方式（根治性或姑息性）不影响并发症发生率。我们的数据表明，对于营养不良的患者以及在出现需要治疗干预的并发症后立即对营养良好的患者，应采用全胃肠外营养（TPN）或使用要素饮食进行肠内喂养的术后营养支持。
