Blackburn G L, Bistrian B R
Surg Clin North Am. 1976 Oct;56(5):1195-224. doi: 10.1016/s0039-6109(16)41038-8.
Nutritional therapy is influence both by disease and nutritional status. In addition, the degree of protein depletion in large part dictates the urgency of aggressive nutritional therapy. The presenceof hypermetabolism where the hormonal substrate response is distinctly antagonistic to replacement therapy precludes effective repair of nutritional depletion. Sepsis further antagonizes efforts at nutritional support. For these reasons no elective or semielective procedure that carries a risk of prolonged stress, hypermetabolism, and sepsis should be performed until adequate nutritional status has been obtained. Enteral feeding programs are to be preferred due to their risk-benefit and cost-benefit ratios. However, impaired digestive function related to disease often limits their use and reliance on parenteral nutrition becomes necessary. While each patient has unique needs and responses, a systematic approach based on objective measurements will most often result in effective nutritional therapy. The accomplished therapist will apply the "modular" approach using the wide variety of products and techniques now available. Ignoring the support of protein synthesis and the preservation of lean body mass can no longer be considered good patient care even in the management of the semistarved state. There is no longer any justification for allowing nosocomial malnutrition to alter the morbidity and mortality of disease. With proper skills in the techniques of protein-calorie therapy and the availability of adequate techniques for nutritional assessment, the science of nutritional therapy now affords the opportunity to provide optimal care for the injured hospitalized patient.
营养治疗受到疾病和营养状况的影响。此外，蛋白质消耗的程度在很大程度上决定了积极营养治疗的紧迫性。存在高代谢状态时，激素底物反应与替代治疗明显拮抗，这会妨碍营养消耗的有效修复。脓毒症会进一步对抗营养支持的努力。出于这些原因，在获得足够的营养状况之前，不应进行任何有延长应激、高代谢和脓毒症风险的择期或半择期手术。由于肠内喂养计划的风险效益比和成本效益比，应优先选择肠内喂养计划。然而，与疾病相关的消化功能受损常常限制了它们的使用，因此必须依赖肠外营养。虽然每个患者都有独特的需求和反应，但基于客观测量的系统方法通常会带来有效的营养治疗。有经验的治疗师会采用“模块化”方法，利用现有的各种产品和技术。即使在半饥饿状态的管理中，忽视蛋白质合成的支持和瘦体重的维持也不能再被视为良好的患者护理。任由医院获得性营养不良改变疾病的发病率和死亡率已不再有任何正当理由。有了蛋白质 - 热量治疗技术的适当技能以及足够的营养评估技术，营养治疗科学现在为为受伤的住院患者提供最佳护理提供了机会。
