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术后护理中的针对性营养策略。

Targeted nutritional strategies in postoperative care.

作者信息

Ham Hye Jin, Kim Jeongmin

机构信息

Department of Nutrition Care, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Anesth Pain Med (Seoul). 2025 Jan;20(1):34-45. doi: 10.17085/apm.24067. Epub 2025 Jan 15.

Abstract

Immunonutrition, which uses specific nutrients to modulate the immune response, has emerged as a vital adjunct to perioperative care. Surgery-induced stress triggers immune responses that can lead to complications, such as infections and delayed wound healing. Traditional nutritional support often overlooks the immunological needs of surgical patients. Immunonutrition addresses this oversight by providing key nutrients, such as arginine, omega-3 fatty acids, glutamine, nucleotides, and antioxidants (vitamins C and E) to enhance immune function and support tissue repair. This review examined the efficacy and safety of immunonutrition in surgical settings, guided by the recommendations of the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism. Both organizations recommend immunonutrition for high-risk or malnourished patients undergoing major surgery and support its use in reducing complications and improving recovery. The key nutrients in immunonutrition aim to improve immune cell function, reduce inflammation, and enhance wound healing. Clinical studies and meta-analyses have demonstrated that immunonutrition lowers the infection rate, shortens the length of hospital stay, and accelerates recovery. Challenges hindering the clinical application of immunonutrition include cost, logistics, and a lack of standardized and personalized protocols. Future studies should focus on biomarker-driven approaches, pharmacogenomics, and innovative nutrient formulations. Addressing these issues will help to integrate immunonutrition into clinical practice, ultimately improving surgical outcomes and patient recovery.

摘要

免疫营养利用特定营养素调节免疫反应,已成为围手术期护理的重要辅助手段。手术引起的应激会触发免疫反应,进而导致感染和伤口愈合延迟等并发症。传统的营养支持往往忽视了外科手术患者的免疫需求。免疫营养通过提供精氨酸、ω-3脂肪酸、谷氨酰胺、核苷酸和抗氧化剂(维生素C和E)等关键营养素来解决这一疏忽,以增强免疫功能并支持组织修复。本综述在美国肠外与肠内营养学会以及欧洲临床营养与代谢学会的建议指导下,研究了免疫营养在手术环境中的疗效和安全性。这两个组织都建议对接受大手术的高危或营养不良患者采用免疫营养,并支持其用于减少并发症和促进康复。免疫营养中的关键营养素旨在改善免疫细胞功能、减轻炎症并促进伤口愈合。临床研究和荟萃分析表明,免疫营养可降低感染率、缩短住院时间并加速康复。阻碍免疫营养临床应用的挑战包括成本、后勤保障以及缺乏标准化和个性化方案。未来的研究应侧重于生物标志物驱动的方法、药物基因组学和创新的营养制剂。解决这些问题将有助于将免疫营养纳入临床实践,最终改善手术效果和患者康复情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0f8/11834873/f91566878ccb/apm-24067f1.jpg

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