Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Dietetics unit, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France.
Department of anesthesia and resuscitation, hospital group Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Sorbonne university, 75000 Paris, France.
J Visc Surg. 2020 Apr;157(2):107-116. doi: 10.1016/j.jviscsurg.2019.07.007. Epub 2019 Jul 28.
Malnutrition increases postoperative morbidity and mortality. The objective of this study was to evaluate preoperative refeeding in malnourished patients at risk of refeeding syndrome (RS).
A retrospective study, conducted between June 2016 and January 2017, reported to the CNIL, compared two groups of malnourished patients: a group of refeeding patients (RP) and a group of non-refeeding patients (NRP). The inclusion criteria were weight loss of more than 10% or albuminemia less than 35g/L and RS risk factor. The primary endpoint was postoperative morbidity. The secondary endpoints were weight change and serum albumin over 6 months.
Seventy-three patients (30 RP and 43 NRP) were included. At the time of initial management, median weight loss was 18% [1-71], while albuminemia was 26g/L [13-40] in the RP group and 32.5g/L [32-48] in the NRP group (P=0.01). The overall postoperative morbidity rate was 88% (83% RP versus 90% NRP, P=0.47), and there was no significant difference between the 2 groups. The rate of anastomotic complications was 4% for RP versus 26% for NRP (P=0.03) after exclusion of liver surgery. Medium-term weight loss tended to be greater in RP (P=0.7). Nutritional support was continued until the third postoperative month in 13% of RPs vs. no NRPs (P=0.0002).
After preoperative renutrition, we did not observe a decrease in morbidity but rather a decrease in the rate of anastomotic complications in favor of the RP group. This study underscores the middle-term importance of nutritional management in view of preserving the benefits of preoperative renutrition.
营养不良会增加术后发病率和死亡率。本研究的目的是评估有再喂养综合征（RS）风险的营养不良患者的术前再喂养。
这是一项回顾性研究，于 2016 年 6 月至 2017 年 1 月进行，向 CNIL 报告，比较了两组营养不良患者：再喂养组（RP）和非再喂养组（NRP）。纳入标准为体重减轻超过 10%或白蛋白血症<35g/L 且有 RS 风险因素。主要终点是术后发病率。次要终点是 6 个月时的体重变化和血清白蛋白。
共纳入 73 例患者（30 例 RP 和 43 例 NRP）。在初始治疗时，RP 组的中位体重减轻为 18%[1-71]，而白蛋白血症为 26g/L[13-40]；NRP 组为 32.5g/L[32-48]（P=0.01）。总的术后发病率为 88%（83%的 RP 与 90%的 NRP，P=0.47），两组之间无显著差异。排除肝手术后，RP 组的吻合口并发症发生率为 4%，而 NRP 组为 26%（P=0.03）。RP 组的中期体重减轻趋势更大（P=0.7）。13%的 RP 继续接受营养支持至术后第三个月，而 NRP 无（P=0.0002）。
术前再营养后，我们没有观察到发病率降低，而是观察到 RP 组的吻合口并发症发生率降低。这项研究强调了中期营养管理的重要性，以保持术前再营养的益处。
