ABSTRACT
Introducción: Los protocolos de recuperación mejorada o precoz, hoy en día, constituyen un eslabón fundamental cuando se habla de mejorar la calidad de la atención perioperatoria que se brinda a los enfermos en aras de disminuir la incidencia de complicaciones. Un acápite fundamental en ellos está en relación con la evaluación, optimización y el apoyo nutricional oportuno. Objetivo: Demostrar la importancia de una adecuada valoración y un oportuno apoyo nutricional perioperatorio en los enfermos programados para procedimientos quirúrgicos cardiacos, así como exponer los aspectos esenciales a considerar en relación a esta temática. Métodos: Se realizó una revisión de la literatura relacionada con el tema. Desarrollo: La desnutrición es uno de los problemas más importantes, así se evidencia en una serie de publicaciones que datan desde 1976 hasta la actualidad. La evaluación del estado nutricional se debe realizar durante todo el período perioperatorio. En sus diferentes fases se describen una serie de factores de riesgos que, cuando están presentes, obligan a instaurar un apoyo nutricional precoz e intensivo por vía parenteral y/o enteral. Conclusiones: La evaluación y la optimización preoperatoria del estado nutricional es vital para una adecuada evolución perioperatoria de los enfermos, por lo que debe constituir parte indispensable de la consulta anestesiológica. El apoyo nutricional debe de ser instaurado de forma precoz una vez identificados los indicadores de riesgo en aras de disminuir la incidencia de complicaciones perioperatorias(AU)
Introduction: Enhanced or fast-track recovery protocols, nowadays, constitute a fundamental link when it comes to improving the quality of perioperative care provided to patients for reducing the incidence of complications. A fundamental section in them is related to the evaluation, optimization and timely nutritional support. Objective: To demonstrate the importance of adequate evaluation and timely perioperative nutritional support in patients scheduled for cardiac surgical procedures. Methods: We carried out a review of the literature related to the subject. Development: Malnutrition is one of the most important problems, as evidenced by a series of publications dating from 1976 to date. The evaluation of nutritional status must be carried out throughout the perioperative period. In its different phases, a series of risk factors are described and, when present, require the introduction of early and intensive parenteral and/or enteral nutritional support. Conclusions: The evaluation and preoperative optimization of the nutritional status is vital for an adequate perioperative evolution of patients, so it must be an indispensable part of the anesthesiological consultation. Nutritional support should be established early once the risk indicators have been identified, in order to reduce the incidence of perioperative complications(AU)
Subject(s)
Humans , Male , Female , Thoracic Surgery/methods , Nutrition Assessment , Perioperative Care/education , Perioperative Care/methods , Review , /methodsABSTRACT
Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.
ABSTRACT
Weight loss and malnutrition are common in cancer patients. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and required for the multidisciplinary approach. Subjective global assessment (SGA) is made by the patients nutritional symptoms and weight loss. The objective assessment, a significant weight loss (>10%) for 6 months is considered an indicator of nutritional deficiency. The mean body index, body fat mass and body protein mass are decreased as cancer stage increases. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count are decreased in advanced cancer stage. Daily energy intake, cabohyderate and Vit B1 intake is decreased according to cancer stage. The patients are divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss%, 6 month weight loss%, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake protein and energy malnutrition. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase in stomach cancer associated morbidity and mortality. The authors concluded that nutritional assessment should be done in cancer patients preoperatively, and with adequate nutritional support, the morbidity and mortality would be decreased.