在主要胃肠道手术中利用腹腔营养:提高质量的机会
Taylor A Aldridge1, Kate K Mathias2, John R Bergquist3
1Division of Surgical Oncology, Hepatobiliary and Pancreatic Surgery, Department of Surgery, Stanford University Stanford, CA, USA.
Clinical nutrition ESPEN
|September 22, 2023
概括
在主要的胃肠道手术患者中使用肠道营养 (PN) 常常偏离ASPEN指南. 质量改善应该针对营养不良患者及时启动PN,避免在营养良好患者中早期使用.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 临床营养学 临床营养学
背景情况:
- 胃肠道营养 (PN) 是一项常见的支持性治疗,用于接受重大胃肠道 (GI) 手术的患者.
- 遵守PN使用的既定指导方针,例如美国肠道和肠道营养学会 (ASPEN) 的指导方针,对于优化患者的治疗结果至关重要.
- 在学术机构内,PN利用的变化可能存在,需要对质量改进进行评估.
研究的目的:
- 评估对肠道营养 (PN) 使用与ASPEN建议在接受重大胃肠道外科瘤手术的患者的一致性.
- 确定与非一致PN使用相关的因素,特别是关于营养不良状态和PN持续时间.
- 确定在这个患者群体中提高PN管理质量的机会.
主要方法:
- 一个81名患者的回顾性审查,他们接受了主要的胃肠道外科瘤手术,并在六个月内接受了PN.
- 数据收集包括临床病理学变量,营养状况以及PN的时间和持续时间.
- 患者根据遵守PN建议进行了分层,并进行了比较,以确定非一致使用的驱动因素.
主要成果:
- 在67.9%的患者中观察到非一致的PN利用率.
- 不一致的主要原因包括营养不良患者的延迟启动 (61.8%) 和营养良好患者的过早启动 (29.0%).
- 很大一部分 (16.0%) 的患者接受了不到五天的PN.
结论:
- 在重大胃肠道瘤手术的外科手术期间使用肠道营养 (PN) 是复杂的,并且经常与ASPEN指南不一致.
- 质量改善举措应优先考虑对营养不良患者及时启动PN.
- 努力还必须旨在防止在营养良好的人群中过早使用PN,以优化资源配置和患者护理.
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