Stoffwechselveränderungen und Ernährungstherapie von Patienten nach großen viszeralchirurgischen Eingriffen und bei chirurgischen Intensivpatienten

Changes of Metabolism and Nutrition Therapy in Patients with Major
Visceral Surgical Interventions and in Surgical Intensive Care
Patients Surgical injury results in a variety of hormonal and
immunologic reactions causing characteristic temporary metabolic
changes (hyperglycemia, muscle protein catabolism). Although useful
during the dawn of mankind, these metabolic changes are
counterproductive in times of modern medicine. Perioperative
nutrition tends to limit such secondary metabolic complications as
much as possible, thereby improving patient prognosis. The
cornerstone of each nutritional therapy is the supplementation of
sufficient amounts of protein or amino acids (1.2-1.5 g/kg/day).
Furthermore, hyperglycemia (>180 mg/dl) should be prevented by
reducing the provision of carbohydrates during the postoperative
acute phase. Oral/enteral nutrition should always be the
application mode of choice. It is essential, however, that the
upper and lower gastrointestinal tract is functioning properly.
Therefore, a close surveillance regarding a potential deterioration
of motility as well as absorption is mandatory. Quantity and
quality of oral/enteral foods depends on the particularities of the
surgical procedure. Patients with malignant diseases will profit
from a preoperative nutritional conditioning (immunonutrition).
Only patients with gastrointestinal dysfunction, who are
simultaneously malnourished, benefit from postoperative parenteral
nutrition. Malnutrition can be identified preoperatively by
subjective global assessment. During parenteral nutrition, it is
particularly important to closely monitor concentrations of blood
glucose, triglycerides, and electrolytes. In critically ill
patients, additional glutamine should be provided during all
periods of parenteral substrate supply, whereas supplementation of
intravenous fat is restricted to patients requiring a prolonged
parenteral nutrition.