Shaw-Stiffel T A, Zarny L A, Pleban W E, Rosman D D, Rudolph R A, Bernstein L H
Nutrition Committee, Bridgeport Hospital, Connecticut 06610.
Nutrition. 1993 Mar-Apr;9(2):140-5.
Various factors may prolong postoperative recovery and the length of stay (LOS) in the hospital. In a retrospective study of 245 adult patients who had no oral intake for 5 days after major gastrointestinal surgery, we used a correlation matrix to describe the population and determine the effects of the following factors on LOS: malnutrition, complication status, stress level, type of surgery, pathology, period of inadequate nutrient intake, and use of nutritional support. LOS was markedly prolonged in malnourished patients compared with those who were not (23.5 +/- 16.5 vs. 16.5 +/- 10.7 days, means +/- SD, p < 0.001). Patients were then grouped into those who had nutritional support and those who had not, and a nutrition classification was derived by examining the uncertainty (entropy) in the data matrix that allowed separation of the population into distinct groups. Nutrition and complication status and days without oral nutrient intake were discriminative. Analysis of variance and multivariate studies were also used to determine whether the presence of malnutrition, complications, both together, or neither could predict LOS and to determine the confounding effect of nutritional support on LOS. A significantly extended LOS persisted for patients with malnutrition or complications and was most prolonged for those with both, but patients who received nutritional support had a greater LOS than those who did not. In addition to the effects of nutritional support, malnutrition, and complication status, LOS correlated with the duration of the postoperative period without oral nutrient intake. We therefore recommend systematic and early nutritional intervention for selected gastrointestinal surgical patients.
多种因素可能会延长术后恢复时间以及住院时长（LOS）。在一项针对245例成年患者的回顾性研究中，这些患者在接受大型胃肠道手术后5天未摄入食物，我们使用相关矩阵来描述该人群，并确定以下因素对住院时长的影响：营养不良、并发症状况、应激水平、手术类型、病理情况、营养摄入不足的时间段以及营养支持的使用情况。与未营养不良的患者相比，营养不良患者的住院时长显著延长（分别为23.5±16.5天和16.5±10.7天，均值±标准差，p<0.001）。然后将患者分为接受营养支持和未接受营养支持两组，并通过检查数据矩阵中的不确定性（熵）得出营养分类，该不确定性可将人群分为不同组。营养状况、并发症状况以及无口服营养摄入的天数具有判别性。方差分析和多变量研究还用于确定营养不良、并发症单独存在、两者同时存在或两者均不存在是否能够预测住院时长，并确定营养支持对住院时长的混杂效应。营养不良或有并发症的患者住院时长仍显著延长，两者皆有的患者住院时长延长最多，但接受营养支持的患者比未接受营养支持的患者住院时长更长。除了营养支持、营养不良和并发症状况的影响外，住院时长还与术后无口服营养摄入的时间段相关。因此，我们建议对选定的胃肠道手术患者进行系统且早期的营养干预。
