Vitello J M
Department of Surgery, University of Illinois at Chicago.
Semin Surg Oncol. 1994 May-Jun;10(3):183-94. doi: 10.1002/ssu.2980100306.
Hospital-based malnutrition is prevalent, especially among patients with gastrointestinal malignancy. Colorectal cancers produce malnutrition through impairment of gastrointestinal function and the liberation of cytokines. Malnourished patients who undergo operation have an increased likelihood of perioperative morbidity and mortality. The performance of a nutritional assessment will aid in the recognition of such patients and provide a risk assessment profile. Preoperative parenteral nutrition is a major expense and delays surgical intervention. Studies to document the efficacy of preoperative parenteral nutrition suffer from design flaws and small sample sizes. Studies that exclusively address patients with cancer of the colon and rectum are absent; therefore results must be extrapolated from the existing literature. Cumulative evidence suggests that a 7-10 day period of parenteral nutrition repletion in the severely malnourished patient will diminish the incidence of postoperative septic complications and mortality. The preoperative treatment of lesser degrees of malnutrition remain controversial. Once the decision has been made to institute preoperative parenteral alimentation, attention to the details of protein requirements and caloric needs should be stressed. The endpoint of therapy is poorly defined. The role of glutamine, arginine, omega-3 fatty acids, and growth hormone in the preoperative repletion process provide an exciting arena for future research.
以医院为基础的营养不良很普遍，尤其是在胃肠道恶性肿瘤患者中。结直肠癌通过损害胃肠功能和释放细胞因子导致营养不良。接受手术的营养不良患者围手术期发病和死亡的可能性增加。进行营养评估有助于识别此类患者并提供风险评估概况。术前肠外营养费用高昂且会延迟手术干预。记录术前肠外营养疗效的研究存在设计缺陷且样本量小。缺乏专门针对结肠直肠癌患者的研究；因此，结果必须从现有文献中推断得出。累积证据表明，对严重营养不良患者进行7至10天的肠外营养补充将降低术后感染并发症的发生率和死亡率。术前对较轻程度营养不良的治疗仍存在争议。一旦决定进行术前肠外营养支持，应强调关注蛋白质需求和热量需求的细节。治疗终点定义不明确。谷氨酰胺、精氨酸、ω-3脂肪酸和生长激素在术前补充过程中的作用为未来研究提供了一个令人兴奋的领域。
