Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza, Italy.
Clin Nutr. 2020 Nov;39(11):3211-3227. doi: 10.1016/j.clnu.2020.03.038. Epub 2020 Apr 18.
BACKGROUND & AIMS: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14-15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients.
This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art.
Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer.
Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient.
营养不良已被确认为不良术后结局的主要危险因素。ESPEN 围手术期营养专题研讨会于 2018 年 10 月 14 日至 15 日在英国诺丁汉举行，本文旨在强调外科患者营养和代谢管理的科学依据。
本文代表了多学科领域专家的意见，以及患者和护理人员的意见，基于现有证据。它强调了当前的技术水平。
外科患者可能存在不同程度的营养不良、肌肉减少症、恶病质、肥胖和肌内脂肪增多。术前优化有助于改善结局。围手术期液体治疗应旨在使患者保持尽可能接近零的液体和电解质平衡。同样，血糖控制对血糖控制不佳的患者尤为重要，HbA1c 每升高 1%，感染并发症和死亡率的风险就会逐渐增加。固定会导致基础能量消耗下降、胰岛素敏感性降低、蛋白质营养和肌肉力量的合成代谢抵抗，所有这些都会损害临床结局。药物营养、预、益生菌和合生元都有一定的作用，在接受胃肠道癌症手术的患者中，证据更为有力。
对外科患者进行营养评估，以及采取适当的干预措施来恢复能量不足、避免体重减轻、维持肠道微生物群并改善功能表现，都是外科患者营养、代谢和功能调理的必要组成部分。
