通信作者:秦新裕教授 通信作者:张忠涛教授 通信作者:陈凛教授 通信作者:吴国豪教授 【引用本文】中华医学会外科学分会胃肠外科学组,中华医学会外科学分会结直肠外科学组,中国医师协会外科医师分会上消化道外科医师委员会. 胃肠外科病人围手术期全程营养管理中国专家共识(2021版)[J]. 中国实用外科杂志,2021,41(10):1111-1125. 胃肠外科病人围手术期全程营养管理 中国专家共识(2021版) 中华医学会外科学分会胃肠外科学组 中华医学会外科学分会结直肠外科学组 中国医师协会外科医师分会上消化道外科医师委员会 中国实用外科杂志,2021,41(10):1111-1125 通信作者:秦新裕:E-mail:qin.xinyu@zs-hospital.sh.cn;张忠涛,E-mail:zhangzht@ccmu.edu.cn;陈凛,E-mail:chenlinbj@vip.sina.com;吴国豪,E-mail:wu.guohao@zs-hospital.sh.cn 胃肠外科病人营养不良发生率高,尤以老年、肿瘤、重症及病理性肥胖病人更为显著[1]。胃肠外科病人营养不良主要表现为营养不足、肌少症、恶病质、肥胖、肌肉脂肪浸润等形式,主要原因是原发疾病状况及治疗引起的营养物质摄入减少、胃肠功能不全、机体代谢变化和自身组织消耗。此外,手术创伤应激导致机体分解代谢增加、炎性反应、蛋白质分解代谢和氮丢失[2]。研究结果显示,大手术病人机体的持续分解代谢可持续至术后数月甚至更长时间才能恢复正氮平衡,严重影响病人组织、器官生理功能恢复,增加术后并发症发生率及病死率,影响病人预后[3]。 近年来,随着微创外科技术发展以及加速康复外科(enhanced recovery after surgery,ERAS)理念的日益普及,外科病人营养治疗理念和策略也随之改变。将营养筛查-评估-干预贯穿于术前、术中、术后以及出院后的疾病治疗和康复过程,实施全程营养管理来实现营养治疗疗效最大化已成为当前外科营养治疗的新理念[2]。为推动和规范我国胃肠外科病人围手术期全程营养管理实践,中华医学会外科学分会胃肠外科学组、中华医学会外科学分会结直肠外科学组和中国医师协会外科医师分会上消化道外科医师委员会共同组织国内胃肠外科和临床营养领域专家,按照目前国际上共识制定的标准流程,总结近年来国内外发表的研究证据,参考相关指南共识及专家意见,经过多次讨论和修改,共同制订《胃肠外科病人围手术期全程营养管理中国专家共识(2021版)》。 本共识采用推荐与评价分级系统(the grading of recommendations,assessment,development,and evaluation,GRADE)进行证据质量和推荐强度评价[4]。提供的推荐意见不仅基于证据质量,还采用Delphi法进行专家调研和投票,投票设“同意”、“基本同意”、“不同意”和“不明确意见,有建议”4个选项,每条推荐意见需获得≥75%参与专家同意方可形成共识。 1 营养风险筛查
2 营养评定及营养不良诊断
3 营养治疗通则
4 术前代谢及营养治疗
5 术后处理及营养治疗
6 围手术期液体及血糖管理
7 特殊营养制剂的选择和补充
8 特殊类型胃肠手术及常见并发症的营养管理
9 出院后营养管理
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