临床营养支持在围手术期患者中的应用_West China Medical Journal

Authors：

陈博 , 熊茂明 ,  孟翔凌

安徽医科大学第一附属医院胃肠外科（合肥 230022）;

Corresponding author：

孟翔凌, Email: anyimxl@163.com

Keywords：

肠外营养; 肠内营养; 营养风险; 营养支持; 临床应用

DOI：

10.7507/1002-0179.201601084

Video：

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Abstract Full text Figures/Tables Video References Cited by

在围手术期患者治疗过程中，临床营养支持发挥了极其重要的作用，能改善存在营养风险患者的不良临床结局，但是目前部分医务工作者对围手术期患者的营养支持应用仍存在欠规范现象，包括支持时机、途径选择等。本文通过对围手术期患者营养支持指征的把握和方案的合理选择等方面进行综述，旨在推广临床营养支持在围手术期患者中的规范化运用。

Citation： 陈博, 熊茂明, 孟翔凌. 临床营养支持在围手术期患者中的应用. West China Medical Journal, 2017, 32(8): 1303-1307. doi: 10.7507/1002-0179.201601084 Copy

1.	Karim SA, Ibrahim B, Tangiisuran B, et al. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. JPEN J Parenter teral Nutr, 2015, 39(4): 482-488.
2.	Jia ZY, Yang J, Tong DN, et al. Screening of nutritional risk and nutritional support in general surgery patients: a survey from Shanghai, China. Int Surg, 2015, 100(5): 841-848.
3.	Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later. Appl Health Econ Health Policy, 2015, 13(2): 167-179.
4.	Fang S, Long J, Tan R, et al. A multicentre assessment of malnutrition, nutritional risk, and application of nutritional support among hospitalized patients in Guangzhou hospitals. Asia Pac J Clin Nutr, 2013, 22(1): 54-59.
5.	Jie B, Jiang ZM, Nolan MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition, 2012, 28(10): 1022-1027.
6.	Rollins H. Nutritional support: how to reduce the risk of harm. Nurs Times, 2011, 107(26): 13.
7.	Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition, 2010, 26(11/12): 1088-1093.
8.	Leung CW, Ryan-Ibarra S, Linares A, et al. Support for policies to improve the nutritional impact of the supplemental nutrition assistance program in California. Am J Public Health, 2015, 105(8): 1576-1580.
9.	Scolapio JS, Smith DJ. Nutrition support in gastrointestinal disease. World Rev Nutr Diet, 2015, 111: 141-145.
10.	Arends J, Bodoky G, Bozzetti F, et al. ESPen guidelines on enteral nutrition: non-surgical oncology. Clin Nutr, 2006, 25(2): 245-259.
11.	Volkert D, Berner YN, Berry E, et al. ESPen guidelines on enteral nutrition: geriatrics. Clin Nutr, 2006, 25(2): 330-360.
12.	Weimann A, Braga M, Harsanyi L, et al. ESPen guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr, 2006, 25(2): 224-244.
13.	Braga M, Ljungqvist O, Soeters P, et al. ESPen guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
14.	Huhmann MB, August DA. Nutrition support in surgical oncology. Nutr Clin Pract, 2009, 24(4): 520-526.
15.	Jiménez Jiménez FJ, Cervera Montes M, Blesa Malpica AL, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SenPE: cardiac patient. Nutr Hosp, 2011, 26(Suppl 2): 76-80.
16.	Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol, 2013, 108(1): 18-37; quiz 38.
17.	Schiavone PA, Piccolo K, Compher C. Application of the a.S.P.E.N. clinical guideline for nutrition support of hospitalized adult patients with obesity: a case study of home parenteral nutrition. Nutr Clin Pract, 2014, 29(1): 73-77.
18.	Wei J, Chen W, Zhu M, et al. Guidelines for parenteral and enteral nutrition support in geriatric patients in China. Asia Pac J Clin Nutr, 2015, 24(2): 336-346.
19.	Tillman EM, Norman JL, Huang EY, et al. Evaluation of parenteral nutrition-associated liver disease in infants with necrotizing enterocolitis before and after the implementation of feeding guidelines. Nutr Clin Pract, 2014, 29(2): 234-237.
20.	Mueller MH, Vandenbussche K, Pelliccia M, et al. enteral nutrition support reduces the necessity of total parenteral nutrition to reach Patient-Specific caloric goals postpancreaticoduodenectomy. South Med J, 2015, 108(12): 748-753.
21.	Tucker A, Ybarra J, Bingham A, et al. American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists. Nutr Clin Pract, 2015, 30(1): 139-146.
22.	Cerruto MA, De Marco V, D’elia C, et al. Fast track surgery to reduce short-term complications following radical cystectomy and intestinal urinary diversion with Vescica Ileale Padovana neobladder: proposal for a tailored enhanced recovery protocol and preliminary report from a pilot study. Urol Int, 2014, 92(1): 41-49.
23.	Huebner M, Mueller S, Schaefer M, et al. Impact of the nutritional risk score in Fast-Track colon surgery. Dig Surg, 2010, 27(5): 436-439.
24.	Xu D, Li J, Song Y, et al. Laparoscopic surgery contributes more to nutritional and immunologic recovery than fast-track care in colorectal cancer. World J Surg Oncol, 2015, 13: 18.
25.	Shao Z, Jin G, Ji W, et al. The role of fast-track surgery in pancreaticoduodenectomy: a retrospective cohort study of 635 consecutive resections. Int J Surg, 2015, 15: 129-133.
26.	Li K, Li JP, Peng NH, et al. Fast-track improves post-operative nutrition and outcomes of colorectal surgery: a single-center prospective trial in China. Asia Pac J Clin Nutr, 2014, 23(1): 41-47.
27.	Blackburn GL, Wollner S, Bistrian BR. Nutrition support in the intensive care unit: an evolving science. Arch Surg, 2010, 145(6): 533-538.
28.	Clifford ME, Banks MD, Ross LJ, et al. A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit. Crit Care Resusc, 2010, 12(3): 149-155.
29.	Delegge MH. Nutrition support in the intensive care patient. J Infus Nurs, 2013, 36(4): 262-268.
30.	Theilla M. Nutrition support for wound healing in the intensive care unit patient. World Rev Nutr Diet, 2013, 105: 179-189.
31.	Lane C, Wedlake LJ, Dougherty L, et al. Attitudes towards and knowledge of nutrition support amongst health care professionals on London intensive care units. J Hum Nutr Diet, 2014,27(Suppl 2): 339-351.
32.	Sharifi MN, Walton A, Chakrabarty G, et al. Nutrition support in intensive care units in England: a snapshot of present practice. Br J Nutr, 2011, 106(8): 1240-1244.
33.	Nellett M, Gregory MP, Lefaiver CA. Pilot study evaluates nutrition for patients receiving mechanical circulatory support in the intensive care unit. AACN Adv Crit Care, 2012, 23(3): 258-269.
34.	Krenitsky J. Glucose control in the intensive care unit: a nutrition support perspective. Nutr Clin Pract, 2011, 26(1): 31-43.
35.	Pielmeier U, Rousing ML, Andreassen S, et al. Decision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system. J Clin Monit Comput, 2012, 26(4): 319-328.
36.	Grau-Carmona T, Bonet-Saris A, García-De-Lorenzo A, et al. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study. Crit Care Med, 2015, 43(1): 31-39.
37.	Glenn JO, Wischmeyer PE. enteral fish oil in critical illness: perspectives and systematic review. Curr Opin Clin Nutr Metab Care, 2014, 17(2): 116-123.
38.	Chen W, Jiang H, Zhou ZY, et al. Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis. Nutrients, 2014, 6(6): 2148-2164.
39.	Wischmeyer PE, Dhaliwal R, Mccall M, et al. Parenteral glutamine supplementation in critical illness: a systematic review. Crit Care, 2014, 18(2): R76.
40.	Mandell SP, Gibran NS. Early enteral nutrition for burn injury. Adv Wound Care (New Rochelle), 2014, 3(1): 64-70.
41.	Wang Q, Liu ZS, Qian Q, et al. Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support. World J Gastroenterol, 2008, 14(32): 5073-5077.
42.	Friese RS. The open abdomen: definitions, management principles, and nutrition support considerations. Nutr Clin Pract, 2012, 27(4): 492-498.
43.	Saalwachter AR, Evans HL, Willcutts KF, et al. A nutrition support team led by general surgeons decreases inappropriate use of total parenteral nutrition on a surgical service. Am Surg, 2004, 70(12): 1107-1111.
44.	Yuan Y, Ren J, Gu G, et al. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis. Nutr Clin Pract, 2011, 26(6): 688-694.
45.	De Luis DA, Izaola O, Cuellar L, et al. A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients. Eur Rev Med Pharmacol Sci, 2010, 14(11): 941-945.
46.	Makhdoom ZA, Komar MJ, Still CD. Nutrition and enterocutaneous fistulas. J Clin Gastroenterol, 2000, 31(3): 195-204.
47.	Kucuk N, Sari M, Midi A, et al. Effectiveness of recombinant human growth hormone for pharyngocutaneous fistula closure. Clin Exp Otorhinolaryngol, 2015, 8(4): 390-395.

1. Karim SA, Ibrahim B, Tangiisuran B, et al. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. JPEN J Parenter teral Nutr, 2015, 39(4): 482-488.
2. Jia ZY, Yang J, Tong DN, et al. Screening of nutritional risk and nutritional support in general surgery patients: a survey from Shanghai, China. Int Surg, 2015, 100(5): 841-848.
3. Tuffaha HW, Roberts S, Chaboyer W, et al. Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later. Appl Health Econ Health Policy, 2015, 13(2): 167-179.
4. Fang S, Long J, Tan R, et al. A multicentre assessment of malnutrition, nutritional risk, and application of nutritional support among hospitalized patients in Guangzhou hospitals. Asia Pac J Clin Nutr, 2013, 22(1): 54-59.
5. Jie B, Jiang ZM, Nolan MT, et al. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition, 2012, 28(10): 1022-1027.
6. Rollins H. Nutritional support: how to reduce the risk of harm. Nurs Times, 2011, 107(26): 13.
7. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition, 2010, 26(11/12): 1088-1093.
8. Leung CW, Ryan-Ibarra S, Linares A, et al. Support for policies to improve the nutritional impact of the supplemental nutrition assistance program in California. Am J Public Health, 2015, 105(8): 1576-1580.
9. Scolapio JS, Smith DJ. Nutrition support in gastrointestinal disease. World Rev Nutr Diet, 2015, 111: 141-145.
10. Arends J, Bodoky G, Bozzetti F, et al. ESPen guidelines on enteral nutrition: non-surgical oncology. Clin Nutr, 2006, 25(2): 245-259.
11. Volkert D, Berner YN, Berry E, et al. ESPen guidelines on enteral nutrition: geriatrics. Clin Nutr, 2006, 25(2): 330-360.
12. Weimann A, Braga M, Harsanyi L, et al. ESPen guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr, 2006, 25(2): 224-244.
13. Braga M, Ljungqvist O, Soeters P, et al. ESPen guidelines on parenteral nutrition: surgery. Clin Nutr, 2009, 28(4): 378-386.
14. Huhmann MB, August DA. Nutrition support in surgical oncology. Nutr Clin Pract, 2009, 24(4): 520-526.
15. Jiménez Jiménez FJ, Cervera Montes M, Blesa Malpica AL, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SenPE: cardiac patient. Nutr Hosp, 2011, 26(Suppl 2): 76-80.
16. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol, 2013, 108(1): 18-37; quiz 38.
17. Schiavone PA, Piccolo K, Compher C. Application of the a.S.P.E.N. clinical guideline for nutrition support of hospitalized adult patients with obesity: a case study of home parenteral nutrition. Nutr Clin Pract, 2014, 29(1): 73-77.
18. Wei J, Chen W, Zhu M, et al. Guidelines for parenteral and enteral nutrition support in geriatric patients in China. Asia Pac J Clin Nutr, 2015, 24(2): 336-346.
19. Tillman EM, Norman JL, Huang EY, et al. Evaluation of parenteral nutrition-associated liver disease in infants with necrotizing enterocolitis before and after the implementation of feeding guidelines. Nutr Clin Pract, 2014, 29(2): 234-237.
20. Mueller MH, Vandenbussche K, Pelliccia M, et al. enteral nutrition support reduces the necessity of total parenteral nutrition to reach Patient-Specific caloric goals postpancreaticoduodenectomy. South Med J, 2015, 108(12): 748-753.
21. Tucker A, Ybarra J, Bingham A, et al. American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists. Nutr Clin Pract, 2015, 30(1): 139-146.
22. Cerruto MA, De Marco V, D’elia C, et al. Fast track surgery to reduce short-term complications following radical cystectomy and intestinal urinary diversion with Vescica Ileale Padovana neobladder: proposal for a tailored enhanced recovery protocol and preliminary report from a pilot study. Urol Int, 2014, 92(1): 41-49.
23. Huebner M, Mueller S, Schaefer M, et al. Impact of the nutritional risk score in Fast-Track colon surgery. Dig Surg, 2010, 27(5): 436-439.
24. Xu D, Li J, Song Y, et al. Laparoscopic surgery contributes more to nutritional and immunologic recovery than fast-track care in colorectal cancer. World J Surg Oncol, 2015, 13: 18.
25. Shao Z, Jin G, Ji W, et al. The role of fast-track surgery in pancreaticoduodenectomy: a retrospective cohort study of 635 consecutive resections. Int J Surg, 2015, 15: 129-133.
26. Li K, Li JP, Peng NH, et al. Fast-track improves post-operative nutrition and outcomes of colorectal surgery: a single-center prospective trial in China. Asia Pac J Clin Nutr, 2014, 23(1): 41-47.
27. Blackburn GL, Wollner S, Bistrian BR. Nutrition support in the intensive care unit: an evolving science. Arch Surg, 2010, 145(6): 533-538.
28. Clifford ME, Banks MD, Ross LJ, et al. A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit. Crit Care Resusc, 2010, 12(3): 149-155.
29. Delegge MH. Nutrition support in the intensive care patient. J Infus Nurs, 2013, 36(4): 262-268.
30. Theilla M. Nutrition support for wound healing in the intensive care unit patient. World Rev Nutr Diet, 2013, 105: 179-189.
31. Lane C, Wedlake LJ, Dougherty L, et al. Attitudes towards and knowledge of nutrition support amongst health care professionals on London intensive care units. J Hum Nutr Diet, 2014,27(Suppl 2): 339-351.
32. Sharifi MN, Walton A, Chakrabarty G, et al. Nutrition support in intensive care units in England: a snapshot of present practice. Br J Nutr, 2011, 106(8): 1240-1244.
33. Nellett M, Gregory MP, Lefaiver CA. Pilot study evaluates nutrition for patients receiving mechanical circulatory support in the intensive care unit. AACN Adv Crit Care, 2012, 23(3): 258-269.
34. Krenitsky J. Glucose control in the intensive care unit: a nutrition support perspective. Nutr Clin Pract, 2011, 26(1): 31-43.
35. Pielmeier U, Rousing ML, Andreassen S, et al. Decision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system. J Clin Monit Comput, 2012, 26(4): 319-328.
36. Grau-Carmona T, Bonet-Saris A, García-De-Lorenzo A, et al. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study. Crit Care Med, 2015, 43(1): 31-39.
37. Glenn JO, Wischmeyer PE. enteral fish oil in critical illness: perspectives and systematic review. Curr Opin Clin Nutr Metab Care, 2014, 17(2): 116-123.
38. Chen W, Jiang H, Zhou ZY, et al. Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis. Nutrients, 2014, 6(6): 2148-2164.
39. Wischmeyer PE, Dhaliwal R, Mccall M, et al. Parenteral glutamine supplementation in critical illness: a systematic review. Crit Care, 2014, 18(2): R76.
40. Mandell SP, Gibran NS. Early enteral nutrition for burn injury. Adv Wound Care (New Rochelle), 2014, 3(1): 64-70.
41. Wang Q, Liu ZS, Qian Q, et al. Treatment of upper gastrointestinal fistula and leakage with personal stage nutrition support. World J Gastroenterol, 2008, 14(32): 5073-5077.
42. Friese RS. The open abdomen: definitions, management principles, and nutrition support considerations. Nutr Clin Pract, 2012, 27(4): 492-498.
43. Saalwachter AR, Evans HL, Willcutts KF, et al. A nutrition support team led by general surgeons decreases inappropriate use of total parenteral nutrition on a surgical service. Am Surg, 2004, 70(12): 1107-1111.
44. Yuan Y, Ren J, Gu G, et al. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis. Nutr Clin Pract, 2011, 26(6): 688-694.
45. De Luis DA, Izaola O, Cuellar L, et al. A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients. Eur Rev Med Pharmacol Sci, 2010, 14(11): 941-945.
46. Makhdoom ZA, Komar MJ, Still CD. Nutrition and enterocutaneous fistulas. J Clin Gastroenterol, 2000, 31(3): 195-204.
47. Kucuk N, Sari M, Midi A, et al. Effectiveness of recombinant human growth hormone for pharyngocutaneous fistula closure. Clin Exp Otorhinolaryngol, 2015, 8(4): 390-395.

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临床营养支持在围手术期患者中的应用

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