营养支持对有营养风险患者结局的影响

营养支持的内涵包括3个部分,即补充、支持和治疗.何时及如何给予患者营养支持均与 改善患者结局有关.美国以1967年全美外科医师大会上Dudrick等报道静脉营养为起点,静脉营养在美国临床实用为43年;我国以1978年全国外科大会上蒋朱明等报道静脉营养为起点,为32年;虽然在国内外医疗单位也把肠外、肠内营养作为标准医疗技术之一,但是对于营养支持改善结局的客观临床研究证据仍然不够.Kondrup等建立的营养风险筛查为合理营养支持改善结局的研究开辟了一个平台.在一项前瞻性队列研究中,根据营养风险筛查2002评价营养支持(肠外营养和肠内营养)对有营养风险患者感染性并发症发生率的影响显示,营养支持组总并发症发生率与无营养支持组相比明显降低,主要由于感染性并发症的发生率降低.有营养风险或已经有营养不良的患者给予适当的营养物质的支持,有可能减少感染性并发症的发生率.希望今后有更多更大样本的队列和随机对照研究,提供更可靠的营养支持可能改善结局的依据.

Impact of nutrition support on the outcomes of patients at nutritional risks

Nutrition support includes three parts: supplementation, support, and therapy. When? and how? to use nutrition support which should be related with clinical outcome of the patients. Parenteral nutrition became widely accepted in the States since the presentation at American College of Surgeons Congress 1967 by Dudrick et al. More detail study of baby growth and development receiving all nutrients exclusively by vein from Wilmore et al 1968. In China, it was Jiang et al reported the clinical applications of parenteral nutrition at Surgical Congress of Chinese Medical Association 1978. Enteral elemental diet and parenteral nutrition for intestinal fistulae illness by Jiang et al 1979 which enrolled by Medline. Although nutrition support has become a standardized technology in China, but evidences on improving the patients' outcomes were still insufficient. After Kondrup et al estsblished Nutritional Risk Screening 2002 tool, the nutrition support could use an evidence-based approaching with outcome. One prospective cohort study based on hospitals in Baltimore and Beijing, using Nutrition Risk Screening 2002 as the tool, have evaluated the impact of nutritional support (both parenteral and enteral nutrition) on the infective complications among patients at nutritional risk and demonstrated that the overall incidence of complications was significantly lower in patients who had received nutritional support, which was achieved mainly due to the decline of the incidence of infective complications. Therefore, support with appropriate nutrients being necessary for patients at nutritional risks or already with malnutrition. However, more cohort studies and randomized controlled studies with larger samples are still required.