Arenas Márquez H, Prieto Chávez E, Hernández Higareda L A, Gutiérrez de la Rosa J L, De Mucha Mora R
Servicio de Apoyo Nutricional, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS Guadalajara.
Rev Invest Clin. 1993 Mar-Apr;45(2):139-43.
We performed a retrospective study in patients undergoing mayor elective surgery of the upper gastrointestinal tract for benign disease receiving perioperative total parenteral nutrition (TPN). We analyzed the clinical charts from patients admitted to the Hospital de Especialidades del Centro Médico de Occidente for this purpose from January 1983 to March 1987, selecting those who had clinical or laboratory criteria of severe malnutrition. They were divided in two groups depending on whether TPN was being indicated as preoperative preparation and continued through the postoperative period (GE = 32 patients), or initiated after surgery (GC = 13 patients). The results show statistical differences in morbidity (GC = 100%, GE = 27%), mortality (GC = 30%, GE = none), need of reoperation (GC = 30%, GE = none) and costs (higher in GE). Complications related to TPN in GC were 23% and 15% in GE, and there were no deaths related on either group. Based on our results, we consider the need of a good selection of candidates to receive preoperative and postoperative TPN when undergoing major elective surgery, which should be continued until they are able to cover their nutritional requirements by oral or enteral route. This applies whenever there is sufficient clinical and laboratory data of severe malnutrition.
我们对因良性疾病接受围手术期全胃肠外营养（TPN）而行上消化道择期大手术的患者进行了一项回顾性研究。为此，我们分析了1983年1月至1987年3月期间入住西医疗中心专科医院的患者的临床病历，选择那些有严重营养不良临床或实验室标准的患者。根据TPN是作为术前准备并持续至术后（GE组 = 32例患者），还是术后开始使用（GC组 = 13例患者），将他们分为两组。结果显示，在发病率（GC组 = 100%，GE组 = 27%）、死亡率（GC组 = 30%，GE组无死亡）、再次手术需求（GC组 = 30%，GE组无）和费用（GE组更高）方面存在统计学差异。GC组与TPN相关的并发症为23%，GE组为15%，两组均无相关死亡病例。基于我们的结果，我们认为在进行择期大手术时，需要精心挑选接受术前和术后TPN的患者，并且应持续使用TPN，直到他们能够通过口服或肠内途径满足营养需求。只要有足够的严重营养不良的临床和实验室数据，均适用此原则。
