減重手術後病人進食與營養狀況分析

Patient' Food Intake and Nutritional Status after Bariatric Surgery

呂忻瑾(Hsin-Chin Lu) ； 郭素娥(Su-E Kuo)

《臺灣膳食營養學雜誌》 9卷1期 (2017/06) Pp. 29-39

https://doi.org/10.6709/TJD.201706_9(1).0003

摘要

減重手術是以限制進食量或減少吸收兩種原理來達到減重的目的，且已經成為治療病態性肥胖及其相關併發症的主要方法，但手術後病人在短期內需克服嘔吐、食慾變差、胃食道逆流、脂肪消化不良等腸胃道不適，長期更可能會出現營養素缺乏的情形，因此術後需要定期於營養門診追蹤以瞭解病人之營養狀態並適時給予調整。我們以病歷回溯的方式蒐集38位接受減重手術病人的資料，20位腹腔鏡迷你胃繞道手術（laparoscopic mini-gastric bypass surgery, LMGB）與18位腹腔鏡縮胃手術（laparoscopic sleeve gastrectomy, LSG）。比較兩組間術後6個月與12個月的熱量及蛋白質攝取，都以LMGB組較高，但僅在術後12個月的熱量攝取達顯著差異，分別是1636.4 ± 536.2 kcal/day與1284.4 ± 307.0 kcal/day；蛋白質攝取部分LMGB組在術後6個月為1.2 g/kg ideal body weight（IBW）/day及術後12個月1.3 g/kg IBW/day，LSG組則兩個時間都維持在0.9 g/kg IBW/day。雖然術後不同時間點LMGB組進食狀況皆較LSG組好，但因術式關係較容易出現檢驗值異常，以鋅（zinc, Zn）、血紅素（hemoglobin, Hb）、維生素B_(12)最常見。而術後12個月LSG組出現前白蛋白偏低的比例較繞道組高，可能與其蛋白質攝取量較少有關。因為術後兩組病人出現的營養問題不相同，建議可針對術式給予個別化的飲食建議以改善其健康狀況。

關鍵字

減重手術 ； 營養素缺乏

並列摘要

Bariatric surgery has been a major way to treat morbid obesity and it's related comorbidities through intake restriction and malabsorption. Patients will undergo gastrointestinal symptoms such as vomiting, poor appetite, gastroesophageal reflux, fat malabsorption at the early post operative stage, and nutrients deficient would be prevalent at the late post operative stage. Therefore, long term regular follow up at nutrition clinic after surgery to check nutritional status and correcting meal pattern are needed. We performed a retrospective study by way of medical charts reviewed, 38 patients' data were collected: 20 patients received laparoscopic mini-gastric bypass (LMGB) and 18 patients received laparoscopic sleeve gastrectomy (LSG). Energy intake were higher in the bypass group both at 6 months and 12 months post operation, but statistically significant differences only appeared at 12 months post operation, which were 1636.4 ± 536.2 kcal/day and 1284.4 ± 307.0 kcal/day respectively. The LMGB group also took in more protein than the LSG group there were 1.2 g/kg IBW/day at 6 months and 1.3 g/kg IBW/day at 12 months post operation. The LSG group maintained 0.9 g/kg ideal body weight (IBW)/day during first year post surgery. Even with the better energy and protein intake of the LMBG group, the surgery mechanism of restricting nutrient absorption leads to low biochemical value, most commonly in zinc, hemoglobin and vitamine B_(12). The higher prevalence of low prealbumin levels in the LSG group at 12 months after surgery may have been caused by insufficient protein intake during the year. According to the differing of nutritional problems between groups, providing personalized dietary advice according to the surgery method employed to improve a patient's health status is suggested.

並列關鍵字

bariatric surgery ； nutrient deficiencies