Perioperative nutrition support in patients with Crohn's disease / 肠外与肠内营养

ABSTRACT

Objective: To investigate the potential role and our experience of perioperative nutritional support in the management of patients with Crohn's disease (CD).Methods: 150 CD patients (male to female=10149) performed with operation and from the year 1997 to 2007 were analyzed retrospectively. Their nutritional index, Crohn's Disease Activity Index (CDAI), sites of lesion, causes and procedures of operation, usage of nutritional support pre-operatively and post-operatively, and operation-related complications were all recorded.Results: Malnutrition, as indicated as BMI10% over the recent 3 months,occurred in 130 patients (88.67%)on admission.After aggressive nutritional support,patients' nutritional index, such as blood haemoglobin, serum albumin, pre-albumin, transferrin and lymphocytes counts all increased significantly pre-operatively and on discharge compared with on admission, while the change of BMI was not significant. For 53 patients receiving home enteral nutrition after discharge, their BMI increased significantly on last follow-up compared with on admission (19.24 vs 17.64, P<0.001). Operation-related complications occurred in 14 patients (9.33%), and two of them died due to severe intra-abdominal infections. Two patients with severe retroperitoneal infection on admission were successfully treated using the damage-control surgery.Conclusion: Malnutrition is a common complication in CD patients receiving surgery, and aggressive perioperative nutritional support may have a positive effect on the morbidity and mortality in such patients. Long-term maintenance therapy with enteral nutrition may delay the postoperative recurrence of the Crohn's disease and should be considered. For critically ill CD, damage-control surgery may get a better outcome than conventional treatment procedures.