加速康复外科时代的围术期营养支持治疗

Overall management of perioperative nutritional support treatment in the enhanced recovery after surgery period

  • 摘要: 只有科学合理给予营养支持治疗,才能最大程度减少并发症,使患者更快更平稳康复。笔者融合加速康复外科集束化管理理念,结合国内外最新研究进展,分析营养风险筛查与营养状况评估;术前、术中、术后期营养支持治疗的重点问题,探讨围术期营养全程管理策略。包括以下几方面:将营养管理融入患者整体管理;避免长时间术前禁食;术后尽早重新建立经口喂养;一旦营养风险较高,应早期开始营养支持治疗;代谢控制(如血糖);减少加重应激相关分解代谢或影响胃肠功能的因素;缩短用于术后呼吸机管理的麻醉药物使用时间;早期活动以促进蛋白质合成和肌肉功能恢复。

     

    Abstract: Only scientific and reasonable nutritional support treatment, can reduce complications to the maximum extent, so that patients will rehabilitate faster and more stably. Authors integrate bundles of care from enhanced recovery after surgery, combined with the latest research progress domestic and overseas, to discuss nutritional status and nutritional risk screening, focus of perioperative nutrition support therapy, key issues on the pre-, intra- and post-operative periods of nutritional support treatment, and strategy of throughout nutritional management during perioperative period. These includes the following aspects: integrating nutrition management into perioperative period management; avoiding fasting before surgery; resuming oral feeding early; early nutritional support therapy for high nutritional risk patients; metabolic control, such as positive control of blood glucose; reducing stress related catabolism or factors affecting gastrointestinal function recovery; decreasing postoperative anesthesia drug use for ventilator management; early activity to promote protein synthesis and muscle function recovery.

     

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