消化道肿瘤患者围手术期的营养支持疗法措施

刘淼，朱珍，律方

中国医学科学院肿瘤医院胸外科

　　肿瘤患者是营养不良的高危人群，消化道肿瘤的病理生理特殊性会加重营养不良，因此，对于此类患者应实施围手术期营养支持疗法。然而，临床对围手术期营养支持疗法的认识仍有不足。减少术前禁食时间、术前合理应用营养支持、术后早期肠内营养及多形式联动是围手术期营养支持疗法的趋优组合策略。由于患者病情复杂多变，在临床实施过程中，医务工作者应结合指南、病情和临床经验，努力改善营养支持疗法的效果。

　　恶性肿瘤患者因疾病消耗、慢性失血，机体会出现负氮平衡，营养不良的患病率高达40%～80%【1】。对于肿瘤患者，术前肠道准备、术后禁食及手术应激所导致的炎性反应，不但限制了营养的摄入和吸收，而且增加了营养的消耗，从而增加了术后营养不良的发生率。有研究表明，营养不良会增加术后并发症，尤其感染的发生风险，亦是并发症发生率和病死率的独立危险因素【2-4】。此外，营养不良会导致免疫功能障碍，继而降低机体对各种抗肿瘤治疗的耐受性，增加治疗副作用【1,5,6】。因此，围手术期营养支持疗法逐渐被认为是肿瘤治疗的综合措施之一。然而，临床上仍存在对患者营养问题认知不足的现象，营养支持疗法常被排在各种治疗措施的最后，甚至被忽略【7】。近年来，围手术期营养支持疗法的目的不再局限于提供热氮量和营养素，还包括改善术后胰岛素抵抗以及促进术后快速康复等。本文旨在阐述消化道肿瘤患者围手术期营养支持疗法的主要措施，以期提高临床医务工作者对患者营养支持疗法相关问题的认识程度。

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原文参见：中华胃肠外科杂志. 2016;19(7):830-832.

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