Department of General Surgery, Advent Health Orlando, Orlando, Florida, USA.
Department of Surgery, University of Florida, Gainesville, Florida, USA.
JPEN J Parenter Enteral Nutr. 2024 Aug;48(6):646-657. doi: 10.1002/jpen.2642. Epub 2024 May 27.
Energy restriction (ER) is a nutrition method to reduce the amount of energy intake while maintaining adequate nutrition. In clinical medicine, applications of ER have been implicated in longevity, mortality, metabolic, immune, and psychological health. However, there are limited studies showing the clinical benefit of ER within the immediate surgical setting. A specific, clinically oriented summary of the potential applications of ER is needed to optimize surgery outcomes for patients. The purpose of this article is to examine how ER can be used for perioperative optimization to improve outcomes for the patient and surgeon. It will also explore how these outcomes can feasibly fit in with enhanced recovery after surgery protocols and can be used as a method for nutrition optimization in surgery. Despite evidence of caloric restriction improving outcomes in critically ill surgical patients, there is not enough evidence to conclude that ER, perioperatively across noncritically ill cohorts, improves postoperative morbidity and mortality in elective surgeries. Nevertheless, a contemporary account of how ER techniques may have a significant role in reducing risk factors of adverse surgical outcomes in this cohort, for example, by encouraging preoperative weight loss contributing to decreased operating times, is reviewed.
能量限制（ER）是一种减少能量摄入的营养方法，同时保持足够的营养。在临床医学中，ER 的应用与长寿、死亡率、代谢、免疫和心理健康有关。然而，很少有研究表明 ER 在手术即刻环境中的临床益处。为了优化患者的手术结果，需要对 ER 的潜在应用进行具体的、以临床为导向的总结。本文旨在探讨 ER 如何用于围手术期优化，以改善患者和外科医生的预后。它还将探讨这些结果如何符合手术后恢复增强协议，并作为手术中营养优化的方法。尽管有证据表明热量限制可以改善重症手术患者的预后，但没有足够的证据表明 ER 在非重症患者队列中，在择期手术中可以降低术后发病率和死亡率。然而，当代的一个观点是，ER 技术如何通过鼓励术前减肥来减少不良手术结果的风险因素，例如，通过减少手术时间来发挥重要作用，这一点正在得到审查。
