Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
JPEN J Parenter Enteral Nutr. 2023 May;47(4):476-481. doi: 10.1002/jpen.2485. Epub 2023 Mar 20.
Surgery and traumatic injury set off a cascade of metabolic changes that are becoming better understood. Recently, strategies and protocols have been developed for optimizing outcomes, and this has yielded beneficial results. This brief review evaluates three specific nutrition or metabolic interventions in the postoperative setting that attempt to optimize outcomes. We limited this to three subspecialty areas including oncologic surgery, orthopedic surgery, and cardiac surgery. These agents included fish oils, factors to prevent dysbiosis, and resistance exercise and its role in enhancing protein update. Where these novel agents fit into the basic tenets of postoperative nutrition interventions does not change the narrative: deliver graduated early enteral feeding to attenuate the metabolic response to surgical stress, maintain the gastrointestinal mucosal barrier, use immune/metabolic modulation to enhance immune response while attenuating excessive inflammation, and support the microbiome.
手术和创伤会引发一系列代谢变化,这些变化正在被更好地理解。最近,已经制定了优化结果的策略和方案,并且已经取得了有益的结果。本综述评估了三种特定的术后营养或代谢干预措施,旨在优化结果。我们将其限制在三个亚专科领域,包括肿瘤外科、骨科和心脏外科。这些药物包括鱼油、预防菌群失调的因素以及阻力运动及其在增强蛋白质更新中的作用。这些新型药物在术后营养干预基本原则中的定位并没有改变这一叙述:提供分级的早期肠内喂养以减轻手术应激引起的代谢反应,维持胃肠道黏膜屏障,使用免疫/代谢调节来增强免疫反应,同时减轻过度炎症,并支持微生物组。