The effect of nutritional status on morbidity after elective surgery for benign gastrointestinal disease

The effect of nutritional status on the morbidity and mortality of major gastrointestinal surgery for benign disease was studied in 32 patients. Malnutrition was defined as a serum albumin less than 3.5 g/dl and a recent weight loss greater than 10%, in addition to any two of the following: weight for height, midarm circumference or triceps skin-fold thickness less than 10th percentile. The morbidity and mortality in the 17 malnourished patients was 59% and 29%, respectively, compared with 20% and 7% in 15 well-nourished patients matched for age and operative procedure (p less than 0.05). After operation, the mean duration of inadequate oral nutritional intake period (IONIP, defined as a caloric intake greater than 60% requirement) was 11.9 days +/- 2.9 (SEM) in well-nourished patients compared with 30.5 days +/- 3.7 in the malnourished group. The longer IONIP in malnourished patients was a consequence of the higher morbidity in this group, thus warranting the consideration of supportive (postoperative) parenteral nutrition in malnourished patients who undergo major gastrointestinal surgery for benign disease.     

胃肠道疾病患者术后早期低热低氮肠外营养临床疗效分析

目的观察胃肠道疾病患者术后早期低热低氮肠外营养（PN）的临床疗效。方法将80例胃肠道疾病术后患者随机分为普通肠外营养组和低热低氮肠外营养组,各40例。检测两组患者术前、术后第3、7天血清白蛋白（ALB）、前白蛋白（PA）、预后营养指数（PNI）、体液及细胞免疫功能指标,记录相关PN支持结果,进行比较分析。结果普通组和低热低氮组在手术后第3天ALB、PA水平及PNI均显著低于术前（p〈0.05）,跟普通组比较,低热低氮组的ALB、PA及PNI升高较快,在术后第7天,其ALB、PA水平、PNI均显著高于普通组（p〈0.05）;低热低氮组的CD3＋、IgG以及普通组的CD3＋、CD4＋、IgG在术后3天显著低于术前,差异有统计学意义（p〈0.05）,术后第7天,低热低氮组IgA、IgG显著高于普通组（p〈0.05）;较普通PN支持,低热氮PN支持能减少胰岛素总用量、减低感染相关并发症和缩短住院时间。结论相对于普通PN,胃肠道疾病患者术后早期低热低氮PN能较快恢复ALB、PA、PNI和免疫功能指标,并能缩短住院时间,其疗效显著,值得推广。     

The response of fibronectin to differing parenteral caloric sources in normal man

The relationship between circulating fibronectin concentration and nutritional status was examined in eight healthy male (31 +/- 1 yr old) volunteers in three nutritional states: the postabsorptive state, after 10 days of protein-caloric starvation, and during the 10th day of refeeding by total parenteral nutrition. Plasma fibronectin was significantly decreased from 330 +/- 22 to 154 +/- 11 micrograms/ml (p less than 0.001) from the postabsorptive to starved state which was accompanied by appropriate changes in body weight, anthropometric measurements, and nitrogen balance. Plasma fibronectin levels were restored to 402 +/- 39 micrograms/ml following 10 days of total parenteral nutrition. The plasma fibronectin response was greater (p less than 0.05) during total parenteral nutrition with dextrose as the nonprotein calorie source as compared to a 50% dextrose/50% lipid regimen. These results suggest that the calorie source must be considered during interpretation of plasma fibronectin levels in patients undergoing parenteral nutrition.     

Nutritional status of surgical patients and the relationship of nutrition to postoperative outcome.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/- 6.5 vs 12 +/- 1.4%) and lower serum albumin levels (25 +/- 4 vs 35 +/- 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.     

Total parenteral nutrition in severe acute pancreatitis

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/- SD = 3.8 +/- 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nutritional management of thoracic duct fistulas. A comparative study of parenteral versus enteral nutrition

Thoracic duct fistulas represent one of the serious technical complications of head and neck surgery, and reoperation for control of the leakage involves considerable morbidity and mortality. In an attempt to define the possibilities of both enteral and parenteral nutrition in the treatment of this problem, two comparable groups of patients were given, respectively, one or the other of these modalities. Significant advantages for parenteral nutrition could be demonstrated regarding duration of therapy (p less than 0.05), closure rate (p less than 0.05), and nutritional response (p less than 0.05). These results strongly recommended the utilization of parenteral nutrition in the primary therapy of thoracic duct fistulas.     

肠外营养支持对胃癌新辅助化疗病人围术期营养状态和免疫功能的影响

目的:探讨肠外营养(PN)支持对胃癌新辅助化疗病人营养状态和免疫功能的影响。方法:选择局部进展期胃癌病人60例,随机分为PN组和对照组,每组各30例,两组病人均可经口进食。对照组病人经口进食;PN组经口进食+术前化疗期间行PN支持,比较两组病人化疗前后、手术前后的营养状况、免疫功能和术后恢复情况。结果:(1)两组病人化疗2周期后血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)呈下降趋势,与化疗前比差异有显著性统计学差异(P0.05),而PN组各指标高于对照组(P0.05)。(2)两组病人化疗2周期后IgA、IgG、IgM、CD4+、CD4+/CD8+呈下降趋势,与化疗前比差异有显著性统计学差异(P0.05),而PN组各指标高于对照组(P0.05)。(3)PN组病人化疗的不良反应少于对照组(P0.05)。(4)术后第7天,PN组病人ALB、TF、PA和IgA、IgG、IgM、CD4+、CD4+/CD8+水平均高于对照组,差异有显著性统计学意义(P0.05)。结论:胃癌新辅助化疗病人在化疗期间给予PN支持有助于提高其化疗期间和术后的营养状态,减少免疫功能损伤和化疗的不良反应。     

Nutritional support of the dysphagic patient: methods, risks, and complications of therapy

The indications, methods, and complications of nutritional support of 90 patients admitted with a primary complaint of dysphagia were reviewed. Patients were divided into two groups based on etiology of dysphagia (central neurologic vs local mechanical dysfunction). All patients on admission exhibited marked malnutrition with an average weight loss of 12 +/- 9.8% body weight, serum transferrin 165 +/- 60.1 mg/dl, and albumin 3.2 +/- 0.85 mg/dl. All patients were placed on either enteral (63%) or parenteral (37%) nutrition. Twenty-seven percent of all patients suffered a complication of nutritional therapy. Patients with nasoenteric tubes had a 10% complication incidence (aspiration or endotracheal placement of tube) resulting in a 30% mortality rate; significantly higher (p less than 0.05) than seen with other modalities. Any form of upper enteric feeding (nasoenteric or gastrostomy) was associated with significantly increased (p less than 0.01) risk of aspiration pneumonia. It is concluded that patients admitted to hospital with dysphagia as the major complaint suffer from severe malnutrition, and that upper gastrointestinal intubation should not be employed for feeding until the dysphagia has resolved.     

The effect of preoperative total parenteral nutrition on surgery outcomes

The effect of preoperative total parenteral nutrition (TPN) on morbidity and mortality was studied in medical records of discharged surgical patients. Patients were classified into two groups on the basis of their ability to meet established criteria for malnutrition and the use of preoperative or postoperative TPN. The control group consisted of 44 patients who received TPN only after surgery or for less than 5 days preoperatively. The experimental group consisted of 26 patients who received treatment for at least 5 days before surgery and/or after surgery. Nutrition parameters measured included serum albumin, total lymphocyte count, hemoglobin, weight, and percent weight loss. Major septic complications (MSC) considered were intra-abdominal sepsis, wound dehiscence, septicemia, and pneumonia. Other complications included respiratory failure, congestive heart failure, fistulas, urinary tract infection, shock, and death. The experimental group showed improvements after surgery in the nutritional parameters listed and had a lower incidence of morbidity and mortality. Deficits in serum albumin, total lymphocyte count, and weight losses greater than or equal to 10% have been significantly (p less than .01) linked to the incidence of MSC. MSC also has been more frequently noted among patients who did not have TPN prior to surgery and who died following surgery. Therefore, preoperative TPN does appear to make a difference in the outcome of surgery.     

Perioperative nutritional support: a randomised clinical trial

Ever since methods of artificial nutritional support became available, attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients. Many trials have addressed this question, but very few have given a meaningful answer because of conceptual and methodological flaws. We therefore undertook a prospective randomised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition (TPN) (n = 51) or total enteral nutrition (TEN) (n = 50) providing 150% basal energy expenditure (BEE) non-protein energy, to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion. 50 patients served as a depleted control group (D) and 49 patients served as a non-depleted reference group (ND) and were operated upon without delay. Depleted control patients suffered significantly more septic complications than did patients in the non-depleted reference group (p < 0.05). There was no significant difference, however, in septic complications between either of the nutritional support groups and the non-depleted control group. In high risk patients, with weight loss >10% of body weight and over 500 ml blood loss during operation, a significant decrease in major complications was observed (p < 0.05) as a result of nutritional support. We conclude that pre-operative nutritional support, in patients with severe depletion, results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients.     

鱼油对腹部大手术后有营养风险患者炎性介质及并发症的影响

目的探讨鱼油干预对腹部大手术后有营养风险患者炎性介质及并发症的影响。方法选取2010年9月至2011年3月昆明医科大学第二附属医院普通外科收住院的胆道探查＋左肝外叶切除术和胃肠肿瘤根治术,且术后当日营养风险筛查2002≥3分的患者60例,按手术类别分为鱼油组30例和对照组30例。术后两组患者均采用等热量、等氮量的3L袋全胃肠外营养治疗,其余电解质、维生素和微量元素等根据检测结果进行调整。肠外营养使用不少于5d,其他治疗按诊疗常规进行。所有患者均在全麻下行开腹手术。术前统一放置尿管,并于术后24h内拔除。两组患者于手术后当日进行手术创伤程度评分,并分别于术前1d,术后1、6d空腹抽取外周静脉血测定白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平,记录相关并发症。鱼油组有2例在术后第3天选择退出研究。结果鱼油组术前1d、术后第1、6天检测IL-6分别为（10．65±4．24）、（29．45±9．39）、（13．37±6．99）ng／L,TNF-α分别为（2．47±1．16）、（23．05±11．43）、（6．05±2．97）ng/L;对照组术前1d、术后第1、6天检测IL-6分别为（11．17±4．67）、（25．10±10．13）、（17．38±7．13）ng／L,TNF-α分别为（2．70±1．63）、（22．11±12．54）、（8．93±3．61）ng／L。术前1d、术后1d两组IL-6及TNF-α比较差异无统计学意义（P=0．787,P=0．206,P=0．983,P=0．852）,术后第6天IL-6两组比较差异无统计学意义（P=0．101）,但鱼油组术后第1—6天降低幅度与对照组相比差异有统计学意义（P=0．036）。术后第6天两组TNF-α比较差异有统计学意义（P=0．024）。鱼油组出现并发症3例（感染性并发症2例）,对照组为6例（感染性并发症5例）,并发症发生率的差异有统计学意义（P=0．002）,其中感染性并发症发生率的差异有统计学意义（P=0．001）,非感染性并发症发生率的差异无统计学意义（P=1．000）。结论腹部大手术后有营养风险患者早期TNF-α和IL-6水平显著增加;鱼油能显著降低腹部大手术后有营养风险患者TNF-α的水平;鱼油使腹部大手术后有营养风险患者的并发症发生率显著降低,其中以感染性并发症降低为主。     

Enteral nutritional support management in a university teaching hospital: team vs nonteam

Current hospital cost containment pressures have prompted a critical evaluation of whether nutritional support teams render more clinically effective and efficient patient care than nonteam management. To address this question with regard to enteral feeding, 102 consecutive hospitalized patients who required enteral nutritional support (ENS) by tube feeding during a 3 1/2-month period were prospectively studied. Fifty patients were managed by a nutritional support team; the other 52 were managed by their primary physicians. Choice of enteral formula, formula modifications, frequency of laboratory tests, and amounts of energy and protein received were recorded daily. In addition, each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities. Team-managed (T) and nonteam-managed (NT) patients received ENS for 632 and 398 days, respectively. The average time period for ENS was significantly longer in the team-managed patients (12.6 +/- 12.1 days vs 7.7 +/- 6.2 days, p less than 0.01). Significantly more of the team patients attained 1.2 X basal energy expenditure (BEE) (37 vs 26, p less than 0.05). Total number of abnormalities in each group was similar (T = 398, NT = 390); however, the abnormalities per day were significantly lower in the team group (T = 0.63 vs NT = 0.98, p less than 0.01). Mechanical (T = 0.05 vs NT = 0.11, p less than 0.01), gastrointestinal (T = 0.99 vs NT = 0.14, p less than 0.05), and metabolic (T = 0.49 vs NT = 0.72, p less than 0.01) abnormalities per day all were significantly lower in the team-managed patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nutritional modulation of protein metabolism after gastrointestinal surgery

BACKGROUND: The metabolic response to surgery includes alterations in protein metabolism, resulting in a net loss of proteins. Protein hypercatabolism is considered an unavoidable consequence of injury, and an important source of morbidity and mortality. Our purpose was to determine the effect of nutrition on protein metabolism following gastrointestinal surgery, and to elucidate whether postoperative protein loss can be prevented with adequate nutritional support. METHODS: Patients who had undergone gastrointestinal surgery were given four different parenteral nutritions with increasing glucose, lipid and amino acid content during the 7 days following surgery. Nitrogen balance, protein synthesis and protein breakdown were determined using in vivo stable isotope labelling. Other metabolites (3-methylhistidine, creatinine, urea, cortisol, glucose, insulin, amino acids and C-reactive protein) were measured. RESULTS: A nutrition-dependent alteration of protein metabolism was found in response to surgical injury. Nutrition modified nitrogen balance, whole-body protein breakdown and, to a lesser extent, whole-body protein synthesis and muscle protein breakdown. The low-energy parenteral nutrition without amino acids produced a negative nitrogen balance (postoperative day 7=-0.381 g protein kg(-1)day(-1)) and important alterations in postoperative protein metabolism that did not normalize during the study period (day 7 protein synthesis=239% and protein breakdown 217% vs preoperative). Patients receiving the two low energy parenteral nutritions containing amino acids had a less negative nitrogen balance (day 7=-0.011 and -0.133 g protein kg(-1)day(-1)) and a transient increase in protein metabolism. The complete parenteral nutrition maintained, during all studied days, protein metabolism parameters within the preoperative reference range (synthesis day 2=92%, day 4=110% day 7=79%; breakdown day 2=85%, day 4=80%, day 7=76% vs preoperative) and a positive nitrogen balance (day 2=+0.0387, day 4=+0.578 and day 7=+0.227 g protein kg(-1)day(-1)). CONCLUSION: Complete nutritional support can prevent protein loss after gastrointestinal surgery and maintain protein metabolism without alterations.     

Successful management of chronic intestinal pseudo-obstruction with home parenteral nutrition

Chronic intestinal pseudo-obstruction is a disorder of gut motility resulting in severe abdominal pain, bloating, nausea, and vomiting after eating. The avoidance of food in order to minimize symptoms causes malnutrition. To date, no medical or surgical treatment has been shown to be of lasting benefit. We treated 10 patients disabled by chronic intestinal pseudo-obstruction using home parenteral nutrition. All were rendered minimally symptomatic as long as they refrained from significant oral intake. Nine of the 10 patients were malnourished prior to the institution of treatment. Home parenteral nutrition increased mean total body weight from 74.7 +/- 2.9 to 93.5 +/- 3.7% (p less than 0.001), mean lean body mass from 78.4 +/- 6.5 to a mean of 92.7 +/- 2.6 (p less than 0.02), and mean body fat from 57.1 +/- 8.8 to 83.8 +/- 8.2% of expected values (p less than 0.05). Mean total body potassium increased from 68.8 +/- 13.1 to 80.5 +/- 10.7 g (p less than 0.05). We conclude that in chronic intestinal pseudo-obstruction, home parenteral nutrition coupled with minimal oral intake effectively relieves symptoms and significantly improves the nutritional depletion.     

Resting energy expenditure in cancer patients before and after gastrointestinal surgery.

The aim of this study was to assess the impact of surgical trauma on energy metabolism in cancer patients. Therefore, resting energy expenditure (REE) was determined before and after surgery in patients with newly detection gastric and colorectal cancer. Preoperative REE was measured in 104 patients. In 65 of these 104 patients REE was also measured on the seventh or eighth postoperative day. Postoperative REE was significantly higher than preoperative REE (mean +/- SD: 1471 +/- 238 vs 1376 +/- 231 kcal; p less than 0.001). After surgery 22 patients were hypermetabolic (REE greater than or equal to 115% predicted energy expenditure) compared with seven hypermetabolic patients before surgery. This hypermetabolism in the postoperative state can be explained by the administration of total parenteral nutrition (TPN), by an increased body temperature mainly as a consequence of postoperative complications and by the surgical trauma itself. Patients who received preoperative TPN (n = 12) showed a 10% increase in REE. Thirteen patients suffered from minor and major postoperative complications; postoperative REE in this group was increased by 10%. Forty patients who had undergone uncomplicated surgery showed a slight but significant increase of 3% in REE after operation. We conclude from this study that the increase in REE resulting from surgical trauma itself is modest at the seventh to eighth postoperative day. Therefore, energy requirements for patients undergoing major elective surgical stress are lower than generally presumed.     

Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

ObjectiveThis multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).MethodsA consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing, China were recruited from March 2007 to July 2008. Data were collected on the nutritional risk screening (NRS-2002), the application of perioperative nutritional support, surgery, complications, and length of stay. A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support.ResultsIn total 1085 patients were recruited, and 512 of them were at nutritional risk. Of the 120 patients with an NRS score at least 5, the complication rate was significantly lower in the preoperative nutrition group compared with the control group (25.6% versus 50.6%, P = 0.008). The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group (13.7 ± 7.9 versus 17.9 ± 11.3 d, P = 0.018). Of the 392 patients with an NRS score from 3 to 4, the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support (P = 1.0 and 0.770, respectively).ConclusionThis finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate.     

The value of nutritional assessment in the surgical patient

The prevalence of malnutrition in Veterans Administration Hospitals has been well documented. Several methods have been proposed to assess nutritional status including prognostic nutritional index (PNI) and instant nutritional assessment (INA). A prospective study was done to evaluate the currently used nutritional assessments and determine their efficacy based on sensitivity and specificity in predicting surgical morbidity and mortality. Data on 46 patients were evaluated for the multiparameter index of PNI, total lymphocyte count and serum albumin for INA, and weight loss alone. In this analysis, intermediate and high risk PNI were combined as positive predictor of complications. Any abnormal value in INA was considered positive as was weight loss of greater than 6% of usual body weight. Sensitivity and specificity of each assessment method were determined by 2 X 2 contingency table, and significance of observed differences between methods was determined by chi 2 analysis. There were no complications or deaths in patients with less than 6% weight loss. All three patients with abnormal albumin and total lymphocyte count had complications as compared to only three of 32 patients when both of these parameters were normal. The PNI was also able to predict complications with an increasing incidence as the PNI increased. Only the difference between specificity of weight loss alone vs INA was statistically significant, p less than 0.05. Thus, weight loss alone can be used as a rapid, inexpensive assessment of nutritional status for predicting postoperative complications.     

Home enteral and parenteral nutritional support: a comparison

Eighteen patients requiring intensive outpatient nutritional support were prospectively reviewed to compare the application of enteral and parenteral approaches. Nine patients received home enteral nutritional support (HEN) for a period of 2 to 15 months via Micro Feeding jejunostomy (MFJ) tubes. The other nine patients received home parenteral nutritional support (HPN) for a period of 3 of 32 months via Broviac catheters. The nine patients on HEN for a period of 2 to 15 months had a mean increase in weight, tricep skinfold thickness, arm muscle circumference, and serum albumin of 9.9 kg (p less than 0.001), 2.5 mm (p less than 0.01), 3.7 cm (p less than 0.05), and 0.73 g/dl (p less than 0.02), respectively. One patient suffered accidental loss of the MFJ tube; otherwise there were no significant complications. The nine patients on HPN for a period of 3 to 32 months had a mean increase in weight, triceps skinfold thickness, arm muscle circumference, and serum albumin of 8.5 kg (p less than .001), 3.5 mm (p less than 0.05), 3.4 cm (p less than 0.05), and 1.09 g/dl (p less than 0.001), respectively. Three patients each experienced one episode of catheter sepsis. These complications were far more serious than arising from the MFJ tube. In addition, the average cost of HPN was found to be 10 to 20 times greater than that of HEN. It is concluded that HEN should be selected over HPN as the course of therapy in all possible cases and that the MFJ tube is a safe, useful, and cost-effective approach.     

Survey of home nutritional support patients

Patients receiving home parenteral nutritional services from a major corporate provider were surveyed using a written questionnaire. The survey questioned the patients about use of home parenteral nutritional services and the quality of life while receiving home parenteral therapy. Patient satisfaction with home nutritional support services, and the impact home therapy has on patient medical, financial and psychosocial status were examined. Life satisfaction measures were compared with that of end stage renal disease patients and the overall United States population. Of the 1140 patients sent the written questionnaire, 347 (30.4%) returned the survey. Half the patients had been placed on home parenteral nutrition services because of short bowel syndrome. The mean length of time respondents had been receiving home parenteral nutrition services was 35 months, reporting approximately one hospitalization per year due to complications of their home parenteral nutrition. Blood infection with catheter as focus was most frequently reported as being responsible for hospitalization. The number of hospitalizations due to complications of home parenteral nutrition therapy was positively correlated with length of time on the program. Overall, respondents were satisfied with their home nutrition services, but were less satisfied with life as a whole when compared to the overall United States population and to end stage renal disease patients.     

肠外营养支持对消化道大手术后病人的治疗作用

目的　探索肠外营养对消化道大手术后病人的治疗作用。方法　试验组 4 6例病人均行深静脉置管 ,肠外营养支持治疗 5～ 10天 ,平均 5 2天。结果　肠外营养支持对消化道大手术后病人的治疗作用显著。结论　肠外营养支持能改善消化道大手术后病人的营养状况 ,对提高疗效、促进吻合口及伤口愈合、减少并发症有重要临床意义。