Feeding the gut early after digestive surgery: results of a nine-year experience
Feeding the gut early after digestive surgery: results of a nine-year experience
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DOI：
10.1054/clnu.2001.0504
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发表时间：
2002-02-01
影响因子：
6.3
通讯作者：
Di Carlo, V
中科院分区：
文献类型：
--
作者：
Braga, M;Gianotti, L;Di Carlo, V
背景和目标：术后早期肠内营养（EEN）应优先于肠外营养，但其临床应用受到可能的胃肠道（GI）不良反应和饲管相关并发症的限制。因此，我们评估了我们的经验，重点是术后早期空肠喂养的安全性和耐受性以及胃肠道不良反应的可能风险因素。方法：前瞻性研究650例癌症消化道大手术后接受EEN治疗的患者。术后12小时内，通过鼻空肠（NJ）营养管或空肠造口导管喂养开始EEN。输注速率逐渐增加，以在术后第4天内达到营养目标（25 kcal/kg/天）。严格的治疗方案的饮食输送和EEN相关的胃肠道不良反应。结果：402例患者行空肠造口术，248例患者行NJ管。在194/650例患者（29.8%）中观察到EEN相关GI不良反应。在136/194例患者中，通过治疗方案成功处理了这些事件。总体而言，650例患者中有592例（91.1%）实现了营养目标。58例（8.9%）受试者因难治性EEN不耐受而转为肠外喂养。腹腔内手术并发症和低血清白蛋白（
Background & Aims: Early enteral nutrition (EEN) after surgery should be preferred to parenteral feeding, but its clinical use is limited for concerns about possible gastrointestinal (GI) adverse effects and feeding tube-related complications. Thus we evaluated our experience focusing on safety and tolerance of early postoperative jejunal feeding and possible risk factors for gastrointestinal adverse effects. Methods: 650 subjects treated with EEN after major digestive surgery for cancer were prospectively studied. EEN was started within 12 hours after operation via a naso-jejunal (NJ) feeding tube or a catheter-feeding jejunostomy. The rate of infusion was progressively increased to reach the nutritional goal (25 kcal/kg/day) within the 4th postoperative day. Rigorous treatment protocols for diet delivery and EEN-related GI adverse effects were applied. Results: 402 patients had a jejunostomy and 248 patients a NJ tube. EEN-related GI adverse effects were observed in 194/650 patients (29.8%). In 136/194 patients, these events were successfully handled by treatment protocols. Overall the nutritional goal was achieved in 592/650 patients (91.1%). Fifty-eight (8.9%) subjects had to be switched to parenteral feeding because of refractory intolerance to EEN. Intra-abdominal surgical complications and low serum albumin (