Aggressive nutritional support of perioperative abdominal surgery in patients with malnutritional risk

論文翻譯標題: 營養不良風險腹部手術病人的手術前後之積極營養支持
  • 劉 明宜

學生論文: Doctoral Thesis


Malnutrition has been recognized as a significant risk factor for the post operated patients especially for those patients undergoing abdominal operations This research is mainly aimed aggressive perioperative nutrition care for malnutrition risk abdominal surgery patients The purposes of the study were to investigate the application of modified peripheral parenteral nutrition (PPN) support to evaluate the influence of proximal jejunostomy output (PJO) reinfusion into the distal small bowel for short bowel syndrome (SBS) patients and to compare the tolerance and nutritional outcomes between the dipeptide- and tripeptide-based enteral formula and a standard enteral formula in abdominal surgery patients Preoperative nutritional support should be given after the nutritional assessment of the patient is admitted Patients are confirmed malnutrition can start receiving nutritional support and most of the studies of this period of preoperative nutritional support advocated in 7 to 10 days by use total parenteral nutrition (TPN) The results of this study indicated that the time frame for hypo-calories with multiple vitamins (MTV) trace elements (TE) and fat emulsion of preoperative PPN support is merely 5 6 ± 2 6 days shorter than previous studies which is about 7-10 days and can significantly improve postoperative prognosis It is critical to shorten the waiting for the surgery to reduce patients discomfort and reduce the complication rate as well as lower postoperative inflammatory responses and better prognosis PPN with added fat emulsion MTV and TE provides valid and effective preoperative nutritional support Patients suffering from proximal jejunum perforation had better to avoid primary anastomosis and require exteriorization of proximal jejunum These patients usually have major problems with short bowel due to the high output of the stoma The output of a proximal jejunostomy contains abundant amounts of enzymes and electrolytes Therefore it is a feasible approach to re-infuse jejunostomy output to regain homeostasis Parenteral nutrition (PN) was initiated immediately after surgery When patients started enteral nutrition we started the proximal jejunostomy output reinfusion protocol Proximal jejunostomy output reinfusion was performed by the patients and continued by them after discharge When proximal jejunostomy output reinfusion could be performed stably PN was stopped The study showed the median length of the proximal jejunum was 20 cm and of the distal small bowel was 77 5 cm in patients who could stably receive proximal jejunostomy output reinfusion alone Three patients did not require home PN; they only required PN during hospitalization Four patients successfully underwent stoma takedown with intestinal anastomosis after 6–7 months without any nutritional or metabolic complications In conclusion short bowel syndrome patients with an adequate length of small bowel and functional colon could avoid long-term PN by receiving reinfusion of proximal jejunostomy output into the distal small bowel Enteral nutrition is a preferred means of support for stimulating gut hormones modulating immunity and maintaining the barrier function of the intestinal mucosa However malabsorption poor emptying and hypoalbuminemia often occur in patients given enteral nutrition Studies have demonstrated that dipeptides and tripeptides are the major products of proteins that are digested Few clinical trials however have investigated the clinical benefits of dipeptide- and tripeptide-based enteral formulas We compared a dipeptide- and tripeptide-based enteral formula with a standard enteral formula for tolerance and nutritional outcomes in abdominal surgery patients A retrospective study design was used to assess the differences between a whole-protein formula (WPF) and a dipeptide- and tripeptide-based formula (PEF) in clinical outcomes Seventy-two adult intensive care unit patients with serum albumin concentrations less than 3 0 g/dL were enrolled in this study Intervention: Patients were divided into two groups (WPF group = 40 patients PEF group = 32 patients) The study patients were fed for at least 7 days with ? 1000 mL of enteral formula infused on at least 3 of the days The results showed the mean serum albumin level on postoperative day (POD) 10 prealbumin levels on POD-5 and POD-10 and total lymphocyte count on POD-5 were significantly higher for the PEF group compared to those for the WPF group (P
獎項日期2015 7月 8
監督員Sue-Joan Chang (Supervisor)