ESPEN guideline: Clinical nutrition in surgery
ESPEN guideline: Clinical nutrition in surgery
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DOI：
10.1016/j.clnu.2017.02.013
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发表时间：
2017-06-01
影响因子：
6.3
通讯作者：
Singer, Pierre
中科院分区：
文献类型：
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作者：
Weimann, Arved;Braga, Marco;Singer, Pierre
早期经口喂养是手术患者首选的营养方式。避免任何营养治疗都会带来大手术后术后喂养不足的风险。考虑到营养不良和喂养不足是术后并发症的危险因素，早期肠内喂养对于任何有营养风险的手术患者尤其重要，尤其是接受上消化道手术的患者。本指南的重点是涵盖加速康复外科 (ERAS) 概念的营养方面以及接受大手术的患者的特殊营养需求，例如，对于癌症，以及尽管进行了最佳围手术期护理仍出现严重并发症的患者。从代谢和营养的角度来看，围手术期护理的关键方面包括： 将营养纳入患者的整体管理中 避免术前长时间禁食 术后尽早重新建立口服喂养 一旦营养风险变得明显，尽早开始营养治疗 代谢控制降低血糖 减少加剧应激相关分解代谢或损害胃肠功能的因素 最大限度缩短术后呼吸机管理中使用麻痹药物的时间 早期活动以促进蛋白质合成和肌肉功能 该指南提出了 37 条临床实践建议。 (C) 2017 年欧洲临床营养和代谢学会。由爱思唯尔有限公司出版。保留所有权利。
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidanc'e of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include:integration of nutrition into the overall management of the patientavoidance of long periods of preoperative fastingre-establishment of oral feeding as early as possible after surgerystart of nutritional therapy early, as soon as a nutritional risk becomes apparentmetabolic control e.g. of blood glucosereduction of factors which exacerbate stress-related catabolism or impair gastrointestinal functionminimized time on paralytic agents for ventilator management in the postoperative periodearly mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice. (C) 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.