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