NUTRITION FOLLOWING GASTRIC OPERATIONS FOR MORBID-OBESITY
NUTRITION FOLLOWING GASTRIC OPERATIONS FOR MORBID-OBESITY
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DOI：
10.1097/00000658-198309000-00011
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发表时间：
1983-01-01
影响因子：
9
通讯作者：
SHIZGAL, HM
中科院分区：
文献类型：
--
作者：
MACLEAN, LD;RHODE, BM;SHIZGAL, HM
通过使用多种同位素稀释技术测量身体成分，评估了238例胃手术后的营养状况，这些胃手术旨在将热量摄入和体重减少到理想的30%以内。分别于术前和术后24个月测定体细胞质量（BCE）和体脂含量。营养不良被定义为总交换性钠（Na e），总交换性钾（K e）的比值大于1.22。收集了96例患者的数据。到24个月时，所有患者的体重平均减轻了术前体重的26%。营养不良者47例，Na e/K e比值为1.23~2.17（1.45 ± 0.03）。身体脂肪减少了34%。营养不良的患者在24个月内比营养正常的患者多失去10%的体重。19名患者的营养不良随着造口扩大而得到解决，饮食咨询帮助了8名患者。18例患者需要再次手术以建立更大的开口，2例患者的内镜扩张成功。在一些营养不良的患者中，需要通过胃造口术长期给予流质饮食。17名在短时间内体重迅速减轻的患者维生素B 12、硫胺素、血清和红细胞叶酸水平较低。1例患者血清硫胺素水平显著降低伴神经病变。在营养不良的患者中发现了虚弱、易疲劳和倦怠的症状。低硫胺素和血清叶酸水平也出现在摄入750千卡液体饮食和标准多种维生素补充剂的患者中。这些患者中未观察到营养不良。在49名营养状况良好的患者中，BCM下降了19%，但Na e/K e保持正常。体重减轻耐受性良好，没有患者需要再次手术或补充流质饮食以增加热量或蛋白质摄入。胃手术后病人的营养不良程度与肠旁路手术后一样严重，但与肝功能衰竭无关。营养不良伴维生素缺乏对接受限制摄入手术的患者是一个巨大的潜在危险，特别是如果手术的目标是恢复接近正常的体重。目前的手术成功地设计成维持一个小的孔口尺寸，因此营养不良的风险在未来可能会增加。
Nutritional status after 238 gastric operations designed to reduce caloric intake and body weight to within 30% of ideal was assessed by measuring body composition using the multiple isotope dilution technique. Body cell mass (BCM) and body fat were quantitated before and at 24 months after operation. Malnutrition was defined as a total exchangeable sodium (Na e) to total exchangeable potassium (K e) ratio greater than 1.22. Data were collected on 96 patients. All had lost a mean of 26% of preoperative weight by 24 months. Significant malnutrition occurred in 47 patients whose Na e/K e ratio ranged from 1.23 to 2.17 (1.45±0.03). There was a 34% reduction in body fat. The malnourished patients lost 10% more BCM by 24 months than did the normally nourished group. Malnutrition resolved as the stoma enlarged in 19 patients, and dietary counselling helped eight patients. Eighteen patients required reoperation to establish a larger orifice, and endoscopic dilatation was successful in two patients. Administration of a liquid diet via the gastrostomy was required for prolonged periods in some malnourished patients. Seventeen patients who had lost weight rapidly over a short time had low vitamin B 12, thiamine, and serum and RBC folate levels. One patient had a markedly decreased serum thiamine level with neuropathy. Symptoms of weakness, easy fatigability, and lassitude were found in the malnourished patients. Low thiamine and serum folate levels were also seen in patients ingesting a liquid diet of 750 kcal with a standard multivitamin supplement. Malnutrition was not seen in these patients. In the 49 patients who remained well nourished, BCM decreased by 19%, but the Na e/K e remained normal. Weight loss was well tolerated, and no patients required reoperation or supplemental liquid diet to increase caloric or protein intake. The degree of malnutrition in patients after gastric operations is as great as following intestinal bypass but is not associated with liver failure. Malnutrition with vitamin deficiency is a great potential hazard in patients who undergo intake-limiting operations, especially if the goal of the operation is to restore near-normal weight. Current operations are successfully designed to maintain a small orifice size, so that the risks of malnutrition are likely to increase in the future.