Медицинская литература. Новинки

 

 

 

 

 

 

Нутритивная поддержка как компонент программы ускоренного выздоровления в гепатопанкреатобилиарной хирургии

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Обзор литературы демонстрирует необходимость дифференцированного подхода к нутритивной поддержке больных, оперированных на органах гепатопанкреатодуоденальной зоны. Представлены сведения о практике проведения нутритивной поддержки больных этой категории. Подчеркнута необходимость оценки риска нутритивной недостаточности до хирургического вмешательства. Коррекцию пищевого статуса следует основывать на потребности в белке и энергии пациента с учетом сопутствующих заболеваний. Методом выбора являются препараты для сипинга. В послеоперационном периоде предпочтение следует отдавать энтеральному питанию. Активно обсуждают вид нутритивной поддержки пациентов, перенесших панкреатодуоденальную резекцию, запланировано рандомизированное клиническое исследование для оценки эффективности энтерального и парентерального питания. Нутритивная поддержка, являясь составной частью программы ускоренного выздоровления, позволяет оптимизировать результаты лечения пациентов, перенесших вмешательства на органах гепатопанкреатодуоденальной зоны. Обязательной является оценка нутритивного статуса больного до операции. Периоперационная коррекция пищевого статуса подразумевает преемственность и мультидисциплинарный подход.

Ключевые слова:
нутритивная поддержка, гепатопанкреатобилиарная хирургия, сипинг, энтеральное питание

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Nutritional support as a component of enhanced recovery program in hepatopancreatobiliary surgery

According to the literature review, a nutritional support for patients after hepatopancreoduodenal surgery requires a differentiated approach. The paper presents data on the experience in providing nutritional support to this kind of patients. It is necessary to stress that nutritional risk screening should be performed prior to surgical intervention. The nutrition is recommended to be adjusted to protein and energy needs of the patient, taking into account concomitant diseases. Products for sip feeding are the method of choice. Enteral nutrition is preferable in the postoperative period. The nutritional support for patients undergoing pancreatoduodenal resection is increasingly recognized, and a randomized clinical trial is to be carried out to evaluate the effectiveness of enteral and parenteral nutrition. As a component of the enhanced recovery program, nutritional support can optimize outcomes in patients who have undergone hepatopancreatoduodenal resection. The nutritional status of a patient should be mandatorily assessed before surgery. Perioperative correction of nutritional status implies continuity and a multidisciplinary approach.

Keywords:
nutritional support, nutritional status, body mass index, hepatopancreatobiliary surgery, sip feeding, enteral nutrition