Периоперационная нутритивная поддержка. Методические рекомендации Федерации анестезиологов и реаниматологов
ISSN (print) 1726-9806     ISSN (online) 1818-474X
#2021-4
PDF_2021-4_7-20
HTML_2021-4_7-20

Ключевые слова

белково-энергетическая недостаточность
нутритивная поддержка
послеоперационный период
предоперационный период
парентеральное питание
энтеральное питание

Как цитировать

Лейдерман И.Н., Грицан А.И., Заболотских И.Б., Мазурок В.А., Поляков И.В., Потапов А.Л., Сытов А.В., Ярошецкий А.И. Периоперационная нутритивная поддержка. Методические рекомендации Федерации анестезиологов и реаниматологов. Вестник интенсивной терапии имени А.И. Салтанова. 2022;(4):7–20. doi:10.21320/1818-474X-2021-4-7-20.

Статистика

Просмотров аннотации: 266
PDF_2021-4_7-20 загрузок: 127
HTML_2021-4_7-20 загрузок: 570
Статистика с 01.07.2024

Язык

Мы в соцсетях

Аннотация

Многочисленные публикации указывают, что, в зависимости от вида патологии, белково-энергетическая недостаточность (БЭН) развивается у 20–50 % хирургических пациентов непосредственно в стационаре в ран- нем послеоперационном периоде. Достаточно большое количество пациентов с хирургической патологией уже госпитализируются в стационары с различной степенью нутритивной недостаточности. От 30 до 69 % больных поступают в клинику с БЭН I–III степени и нуждаются в обязательном проведении нутритивной поддержки. Факторы риска развития БЭН выявляют у 60–70 % госпитализированных. В методических рекомендациях представлены основные принципы проведения нутритивной поддержки в периоперационном периоде.
PDF_2021-4_7-20
HTML_2021-4_7-20

Библиографические ссылки

  1. Луфт В.М., Афончиков В.С., Дмитриев А.В. и др. Руководство по клиническому питанию: руководство. СПб.: Арт-Экспресс, 2016. [Luft V.M., Afonchikov V.S., Dmitriev A.V., et al. Clinical nutrition manual. SPb.: Art-Express, 2016. (In Russ)]
  2. Kondrup J., Allison S.P., Elia M., et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22(4): 415–21. DOI: 10.1016/s0261-5614(03)00098-0
  3. Lobo D.N., Gianotti L., Adiamah A., et al. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020; 39(11): 3211–27. DOI: 10.1016/j.clnu.2020.03.038
  4. Энтеральное и парентеральное питание: национальное руководство / под ред. А.И. Салтанова, Т.С. Поповой. М.: ГЭОТАР-Медиа, 2014. [Enteral and parenteral nutrition: national guidance / eds. A.I. Saltanov, T.S. Popova. M.: GEOTAR-Media, 2014. (In Russ)]
  5. Bozzetti F. Chemotherapy-Induced Sarcopenia. Curr Treat Options Oncol. 2020; 21(1): 7. DOI: 10.1007/s11864-019-0691-9
  6. Салтанов А.И., Сельчук В.И., Снеговой А.В. Основы нутритивной поддержки в онкологической клинике (руководство для врачей). М.: МЕДпресс-информ, 2009. [Saltanov A.I., Selchuk V.I., Snegovoy A.V. Fundamentals of Nutritional Support in a Cancer Clinic (A Guide for Physicians). M.: MEDpress-inform, 2009. (In Russ)]
  7. Arends J., Bachmann P., Baracos V., et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11–48. DOI: 10.1016/j.clnu.2016.07.015
  8. Клинические рекомендации. Анестезиология-реаниматология/ Под. ред. И.Б. Заболотских, Е.М. Шифмана. М.: ГЭОТАР-Медиа, 2016. [Clinical guidelines. Anesthesiology-resuscitation. Eds.: I.B. Zabolotskikh, E.M. Shifman. M.: GEOTAR-Media, 2016. (In Russ)]
  9. Charlton K., Nichols C., Bowden S., et al. Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up. Eur J Clin Nutr. 2012; 66(11): 1224–8. DOI: 10.1038/ejcn.2012.130
  10. Weimann A., Braga M., Carli F., et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017; 36(3): 623:650. DOI: 10.1016/j.clnu.2017.02.013
  11. Sun Z., Kong X.J., Jing X., et al. Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. PLoS One. 2015; 10(7): 0132857. DOI: 10.1371/journal.pone.0132857
  12. Shachar S.S., Williams G.R., Muss H.B., Nishijima T.F. Prognostic value of sarcopenia in adults with solid tumours: A metaanalysis and systematic review. Eur J Cancer. 2016; 57: 58–67. DOI: 10.1016/j.ejca.2015.12.030
  13. Kuwada K., Kuroda S., Kikuchi S., et al. Clinical Impact of Sarcopenia on Gastric Cancer. Anticancer Res. 2019; 39(5): 2241–9. DOI: 10.21873/anticanres.13340
  14. Järvelä K., Maaranen P., Sisto T. Pre-operative oral carbohydrate treatment before coronary artery bypass surgery. Acta Anaesthesiol Scand. 2008; 52(6): 793–7. DOI: 10.1111/j.1399-6576.2008.01660.x
  15. Wang Z.G., Wang Q., Wang W.J., Qin H.L. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010; 97(3): 317–27. DOI: 10.1002/bjs.6963
  16. Gustafsson U.O., Scott M.J., Schwenk W., et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr. 2012; 31(6): 783–800. DOI: 10.1016/j.clnu.2012.08.013
  17. Gianotti L., Biffi R., Sandini M., et al. Preoperative oral carbohydrate load versus placebo in major elective abdominal surgery (PROCY): a randomized, placebo-controlled, multicenter, phase III trial. Ann Surg. 2018; 267(4): 623–30. DOI: 10.1097/SLA.0000000000002325
  18. Kaska M., Grosmanova T., Havel E., et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery—a randomized controlled trial. Wien Klin Wochenschr. 2010; 122(1–2): 23–30. DOI: 10.1007/s00508-009-1291-7
  19. Elia M., Normand C., Norman K., Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016; 35(2): 370– 80. DOI: 10.1016/j.clnu.2015.05.010
  20. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017; 126(3): 376–93. DOI: 10.1097/ALN.0000000000001452
  21. Потапов А.Л. Дополнительное пероральное питание в составе нутритивной поддержки в онкохирургии. Вестник анестезиологии и реаниматологии. 2020; 17(2): 64–69. DOI:10.21292/2078-5658-2020-17-2-64-69 [Potapov A.L. Oral nutritional supplements in nutrition support for cancer surgery. Messenger of anesthesiology and resuscitation. 2020; 17(2): 64–9. (In Russ.)]
  22. Charlton K., Nichols C., Bowden S., et al. Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up. Eur J Clin Nutr. 2012; 66(11): 1224–8. DOI: 10.1038/ejcn.2012.130
  23. Osland E., Yunus R.M., Khan S., Memon M.A. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN. 2011; 35(4): 473–87. DOI: 10.1177/0148607110385698
  24. Dizdar O.S., Baspınar O., Kocer D., et al. Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic. Nutrients. 2016; 8(3): 124. DOI: 10.3390/nu8030124
  25. Barker L.A., Gray C., Wilson L., et al. Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomized controlled trial. Eur J Clin Nutr. 2013; 67(8): 802–7. DOI: 10.1038/ejcn.2013.117
  26. Bharadwaj S., Trivax B., Tandon P., et al. Should perioperative immunonutrition for elective surgery be the current standard of care? Gastroenterology Report. 2016; 4(2): 87–95. DOI: 10.1093/gastro/gow008
  27. Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991; 325(8): 525–32. DOI: 10.1056/NEJM199108223250801
  28. Bozzetti F., Gavazzi C., Miceli R., et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. J Parenteral Enteral Nutr. 2000; 24(1):7–14. DOI: 10.1177/014860710002400107
  29. Fukuda Y., Yamamoto K., Hirao M., et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015; 22(Suppl 3): S778–85. DOI: 10.1245/s10434-015-4820-9
  30. Gerritsen A., Besselink M.G., Gouma D.J., et al. Systematic review of five feeding routes after pancreatoduodenectomy. Br J Surg. 2013; 100(5): 589–98. DOI: 10.1002/bjs.9049
  31. Adiamah A., Ranat R., Gomez D. Enteral versus parenteral nutrition following pancreaticoduodenectomy: a systematic review and meta-analysis. HPB (Oxford). 2019; 21(7): 793–801. DOI: 10.1016/j.hpb.2019.01.005
  32. Lee S.H., Jang J.Y., Kim H.W., et al. Effects of early enteral nutrition on patients after emergency gastrointestinal surgery: a propensity score matching analysis. Medicine (Baltim). 2014; 93(28): 323. DOI: 10.1097/MD.0000000000000323
  33. Herbert G., Perry R., Andersen H.K., et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2018; 10(10):CD004080. DOI: 10.1002/14651858
  34. Затевахин И.И., Пасечник И.Н., Ачкасов С.И. и др. Клинические рекомендации по внедрению программы ускоренного выздоровления пациентов после плановых хирургических вмешательств на ободочной кишке. Доктор.Ру. Анестезиология и реаниматология. Мед. реабилитация. 2016;12–1(129): 8–21. [Zatevakhin I.I., Pasechnik I.N., Achkasov S.I., et al. Clinical Guidelines on Implementation of Enhanced-Recovery-After-Surgery Program for Elective Colorectal Surgery. Doctor.ru. Anesthesiology and Critical Care Medicine. 2016; 12–1(129): 8–21. (In Russ)]
  35. Carmichael J.C., Keller D.S., Baldini G., et al. Clinical Practice Guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis. Colon. Rectum. 2017; 60(8): 761–84. DOI: 10.1097/DCR.0000000000000883
  36. Лейдерман И.Н., Ярошецкий А.И. К вопросу о потребности в белке пациентов отделений реанимации и интенсивной терапии. Вестник интенсивной терапии им. А.И. Салтанова. 2018; 3: 59–66. DOI: 10.21320/1818–474X-2018-3-59-66 [Leyderman I.N., Yaroshetskiy A.I. Discussing protein requirements of intensive care UNIT (ICU) patients. Alexander Saltanov Intensive Care Herald. 2018; 3: 59–66. (In Russ)]
  37. Leyderman I., Yaroshetskiy A., Klek S. Protein requirements in critical illness: do we really know why to give so much? Journal of Parenteral and Enteral Nutrition. 2020; 44(4): 589–98. DOI: 10.1002/jpen.1792
  38. Gianotti L., Braga M., Vignali A., et al. Effect of route of delivery and formulation of postoperative nutritional support in patients undergoing major operations for malignant neoplasms. Arch Surg. 1997; 132(11): 1222–9.
  39. Zhu X., Wu Y., Qiu Y., et al. Comparative analysis of the efficacy and complications of nasojejunal and jejunostomy on patients undergoing pancreaticoduodenectomy. J Parenter Enteral Nutr. 2014; 38(8): 996–1002. DOI: 10.1177/0148607113500694
  40. Sica G.S., Sujendran V., Wheeler J., et al. Needle catheter jejunostomy at esophagectomy for cancer. J Surg Oncol. 2005; 91(4): 276–9. DOI: 10.1002/jso.20314
  41. Chin K.F., Townsend S., Wong W., Miller G.V. A prospective cohort study of feeding needle catheter jejunostomy in an upper gastrointestinal surgical unit. Clin Nutr. 2004; 23(4): 691–6. DOI: 10.1016/j.clnu.2003.11.002
  42. Ramamurthy A., Negi S.S., Chaudhary A. Prophylactic tube jejunostomy: a worthwhile undertaking. Surg Today. 2008; 38(5):420–4. DOI: 10.1007/s00595-007-3650-1
  43. Siow S.L., Mahendran H.A., Wong C.M., et al. Laparoscopic T-tube feeding jejunostomy as an adjunct to staging laparoscopy for upper gastrointestinal malignancies: the technique and review of outcomes.BMC Surg. 2017; 17(1): 25. DOI: 10.1186/s12893-017-0221-2
  44. Lien H.C., Chang C.S., Chen G.H. Can percutaneous endoscopic jejunostomy prevent gastroesophageal reflux in patients with preexisting esophagitis? Am J Gastroenterol. 2000; 95(12): 3439–43. DOI: 10.1111/j.1572-0241.2000.03281.x
  45. Heidegger C.P., Berger M.M., Graf S., et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013; 381(9864): 385–93. DOI: 10.1016/S0140-6736(12)61351-8
  46. Pichard C., Schwarz G., Frei A., et al. Economic investigation of the use of three-compartment total parenteral nutrition bag: prospective randomized unblinded controlled study. Clin Nutr. 2000; 19(4): 245–51. DOI: 10.1054/clnu.2000.0106
  47. Menne R., Adolph M., Brock E., et al. Cost analysis of parenteral nutrition regimens in the intensive care unit: three-compartment bag system vs multibottle system. J Parenter Enteral Nutr. 2008; 32(6): 606–12. DOI: 10.1177/0148607108322404
  48. Turpin R.S., Canada T., Rosenthal V., et al. IMPROVE Study Group. Bloodstream infections associated with parenteral nutrition preparation methods in the United States: a retrospective, large database analysis. J Parenter Enteral Nutr. 2012; 36(2): 169–76.
  49. Adolph M. Lipid emulsions in total parenteral nutrition-state of the art and future perspectives. Clinical Nutrition. 2001; 20(S4):11–4.
  50. Grau T., Ruiz de Adana J., Zubillaga S., et al. Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients; effect of infectious morbidity and mortality. Nutr Hosp. 2003; 18: 159–66.
  51. Sadu Singh B.K.S., Narayanan S.S., Khor B.H., et al. Composition and Functionality of Lipid Emulsions in Parenteral Nutrition: Examining Evidence in Clinical Applications. Front Pharmacol. 2020; 11: 506. DOI: 10.3389/fphar.2020.00506
  52. Faucher M., Bregeon F., Gainnier M., et al. Cardiopulmonary Effects of Lipid Emulsions in Patients With ARDS. Chest. 2003; 124: 285–291.
  53. Jiang Z., Jiang H. The clinical efficacy of glutamine dipeptides on postoperative patients: an updated systematic review of randomized controlled trials from Europe and Asia (1997–2005). Zhonghua Yi Xue Za Zhi. 2006; 86(23): 1610–4.
  54. Wang Y., Jiang Z.M., Nolan M.T., et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. J Parenter Enteral Nutr. 2010; 34(5): 521–9. DOI: 10.1177/0148607110362587
  55. Bollhalder L., Pfeil A.M., Tomonaga Y., Schwenkglenks M. A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. Clin Nutr. 2013; 32(2): 213–23.
  56. Sandini M., Nespoli L., Oldani M., et al. Effect of glutamine dipeptide supplementation on primary outcomes for elective major surgery: systematic review and meta-analysis. Nutrients. 2015; 7(1): 481– 99. DOI: 10.3390/nu7010481
  57. Perez-Barcena J., Marce P., Zabalegui-Pérez A., et al. A randomized trial of intravenous glutamine supplementation in trauma ICU patients. Intensive Care Med. 2014; 40(4): 539–47. DOI: 10.1007/s00134-014-3230-y
  58. Ziegler T.R., May A.K., Hebbar G., et al. Efficacy and safety of glutamine-supplemented parenteral nutrition in surgical ICU patients: an American multicenter randomized controlled trial. Ann Surg. 2016; 263(4): 646–55. DOI: 10.1097/SLA.0000000000001487
  59. Andrews P.J.D., Avenell A., Noble D.W., et al. Randomized trial of glutamine, selenium, or both, to supplemental parenteral nutrition for critically ill patients. BMJ. 2011; 342: 1542.
  60. Heyland D., Muscedere J., Wischmeyer P.E., et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med. 2013; 368(16): 1489–97. DOI: 10.1056/NEJMoa1212722
  61. Cui Y., Hu L., Liu Y., et al. Intravenous alanyl-L-glutamine balances glucose-insulin homeostasis and facilitates recovery on patients undergoing colonic resection—a randomised trial. Eur J Anaestesiol. 2014; 31: 212–8. DOI: 10.1097/EJA.0b013e328360c6b9
  62. Wang Y., Jiang Z.M., Nolan M.T., et al. The impact of glutamine dipeptide-supplemented parenteral nutrition on outcomes of surgical patients: a meta-analysis of randomized clinical trials. J Parenter Enteral Nutr. 2010; 34: 521–9. DOI: 10.1177/0148607110362587
  63. Bollhalder L., Pfeil A.M., Tomonaga Y., Schwenkglenks M. A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation. Clin Nutr. 2013; 32: 213–23. DOI: 10.1016/j.clnu.2012.11.003
  64. Novak F., Heyland D.K., Avenell A., et al. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med. 2002; 30(9): 2022–9. DOI: 10.1097/00003246-200209000-00011
  65. Wichmann M.W., Thul P., Czarnetzki H.-D., et al. Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (MLF 541): Data from a prospective, randomized, multicenter trial. Crit Care Med. 2007; 35(3): 700–6. DOI: 10.1097/01.CCM.0000257465.60287.AC
  66. Grau-Carmona T., Bonet-Saris A., Abelardo G.L., et al. Influence of n-3 polyunsaturated fatty acids enriched lipid emulsions on nosocomial infections and clinical outcomes in critically ill patients: ICU lipids study Crit Care Med. 2015; 43(1): 31–9. DOI: 10.1097/CCM.0000000000000612
  67. Pradelli L., Mayer K., Klek S., et al. Omega-3 fatty-acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and trial sequential analysis. J Parenter Enter Nutr. 2020; 44(1): 44–57. DOI: 10.1002/jpen.1672
  68. Лейдерман И.Н., Ярошецкий А.И., Кокарев Е.А., Мазурок В.А. Парентеральное питание. Вопросы и ответы. Руководство для врачей. СПб.: Онли-Пресс, 2016. [Leiderman I.N., Yaroshetskiy A.I., Kokarev E.A., Mazurok V.A. Parenteral nutrition. Questions and answers. A guide for doctors. St. Petersburg: Online-Press, 2016. (In Russ)]
  69. Lau C.S., Chamberlain R.S. Enhanced Recovery after Surgery Programs Improve Patient Outcomes and Recovery: A Meta-analysis. World J Surg. 2017; 41(4): 899–913. DOI: 10.1007/s00268-016-3807-4
  70. Bu J., Li N., Huang X., et al. Feasibility of Fast-Track Surgery in Elderly Patients with Gastric Cancer. J Gastrointest Surg. 2015; 19(8): 1391–8. DOI: 10.1007/s11605-015-2839-7
  71. Willcutts K.F., Chung M.C., Erenberg C.L., et al. Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis. Ann Surg. 2016; 264(1): 54–63. DOI: 10.1097/SLA.0000000000001644
  72. Shimizu N., Oki E., Tanizawa Y., et al. Effect of early oral feeding on length of hospital stay following gastrectomy for gastric cancer: a Japanese multicenter, randomized controlled trial. Surgery Today. 2018; 48(9): 865–74. DOI: 10.1007/s00595-018-1665-4
  73. Low D.E., Allum W., De Manzoni G., et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg. 2019; 43(2): 299–330. DOI: 10.1007/s00268-018-4786-4
  74. Потапов А.Л., Хороненко В.Э., Гамеева Е.В. и др. Дополнительное пероральное питание: прикладная классификация смесей и ключевые правила применения в онкологии. Вопросы питания. 2020; 89(1): 69–76. DOI: 10.24411/0042-8833-2020-10008 [Potapov A.L., Khoronenko V.E., Gameeva E.V., et al. Oral nutrition supplements: applied classification of formulas and basic rules of their prescribing in oncology. Voprosypitaniia [Problems of Nutrition. 2020; 89(1): 69–76. DOI: 10.24411/0042-8833-2020-10008 (In Russ)]
  75. West M.A., Wischmeyer P.E., Grocott M.P.W. Prehabilitation and Nutritional Support to Improve Perioperative Outcomes. Curr Anesthesiol Rep. 2017; 7(4): 340–9. DOI: 10.1007/s40140-017-0245-2
Лицензия Creative Commons

Это произведение доступно по лицензии Creative Commons «Attribution-NonCommercial-ShareAlike» («Атрибуция — Некоммерческое использование — На тех же условиях») 4.0 Всемирная.

Copyright (c) 2022 ВЕСТНИК ИНТЕНСИВНОЙ ТЕРАПИИ имени А.И. САЛТАНОВА