Can't We Just Let Them Eat?-Defining and Addressing Under-Use of the Oral Route in a Post-Surgical Ward

早期的術後營養有助於疾病預後。然而，在某些地區，仍採取術後禁食的保守策略。在某大型第三層轉診教學醫院，對綜合外科病房之術後營養支持方法做基準檢測，進行回溯性評估。本研究共蒐集38位，於2010年11月至2011年5月，接受婦科或泌尿科手術的患者資料，其中包括人口學、營養狀態、手術執行細節、術後併發症、營養支持方式，及術後開始固態飲食的時間。評估術後第一週的能量與蛋白質之供應量及其適足程度。其中16位患者，沒有執行口服或腸道營養的測試，術後直接給予靜脈營養。給予靜脈營養的原因，包括觀察或預期該患者可能有腸胃道蠕動障礙，以及患者缺乏消化道造口。而這些患者，確顯示有較長的住院天數，及更高的術後併發症比率。令人質疑的是，這麼高比率的患者立即且持續的靜脈營養，病人無法表現其口服耐受度，且無法得到從早期腸道餵食的預期效益。沒有任何一位患者，在術後第一週，獲得足夠的熱量及蛋白質需求。儘管有文獻支持，骨盆腔手術後，可以實施早期的術後營養，但要被全面採納，仍有挑戰性。可能需要採用多種策略去改變現有的做法，並提升早期進食，或施用腸道營養。

關鍵字

婦科手術；腸阻塞；營養支持；靜脈營養；泌尿科手術

並列摘要

Early postoperative nutrition improves outcomes. However, postoperative fasting is a tradition that persists in some areas of surgical practice. This retrospective audit was performed to benchmark current nutrition support practices on a mixed specialty surgical ward in a large tertiary-referral teaching hospital. Thirty-eight consecutive patients, who were undergoing gynaecological or urological surgical procedures between November 2010 and May 2011, had data collected including demographics, nutritional status, details of surgery performed, postoperative complications, modes of nutrition support and time taken to progress to solid oral diet. Energy and protein provision and adequacy was estimated for the first week postoperatively. Sixteen patients commenced parenteral nutrition postoperatively without any trial of oral or enteral nutrition. Reasons for using parenteral nutrition included observed or expected gut dysmotility and lack of enteral access for feeding. These patients did demonstrate longer length of stay and higher rates of postoperative complications. Given the proportion of patients initiated immediately on parenteral nutrition and maintained on it alone, it can be argued that these patients are not able to demonstrate tolerance and receive the benefits of early enteral feeding predicted by studies within these patient groups. None of the patients met their energy and protein requirements in the first week postoperatively. Despite support in the literature, it can be challenging to implement early postoperative nutrition support after pelvic surgery. It may be necessary to employ a variety of strategies to change this aspect of practice and promote earlier introduction of an oral diet or the use of enteral nutrition.

並列關鍵字

gynecological surgery ； ileus ； nutritional support ； parenteral nutrition ； urological surgery

參考文獻

Cerantola Y, Grass F, Cristaudi A, Demartines N, Schafer M, Hubner M. Perioperative nutrition in abdominal surgery: recommendations and reality. Gastroenterol Res Prac. 2011; 2011:1-8.

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Bisgaard T, Kehlet H. Early oral feeding after elective abdominal surgery – what are the issues? Nutrition. 2002;18: 944-8.

國際替代計量

Can't We Just Let Them Eat?-Defining and Addressing Under-Use of the Oral Route in a Post-Surgical Ward

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