주요 복부 수술에서의 수술 전 영양 평가와 TPN 투여의 효과
The Preoperative Nutritional Assessment and the Effect of TPN in Major Abdominal Surgery
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Abstract
It’s well established that nutrition support can reduce postoperative morbidity and mortality in major abdominal surgery. However nutrition support is not for everybody undergoing surgery and several well designed studies showed that the effect of it depends on preoperative nutrition status and postoperative duration of NPO. In conclusion it is imperative to carefully choose which patients should receive nutrition support and make an optimized plan for it. We have been consulting and monitoring TPN support only requested patients. In this article we assess preoperative nutrition status based on A.S.P.E.N. guideline in 2002 and the effect of TPN in all patients undergoing major abdominal surgery. This study included 191 adult patients at Seoul National University Hospital department of general surgery from January to June in 2006. We retrospectively analyzed age, sex, disease, operation and nutrition status was evaluated by albumin level, weight loss during last 6 months. The effects of TPN on outcome such as weight loss during hospital stay, complications during the first 30 days after surgery and length of hospital stay were investigated and compared statistically among 3 groups-TPN treatment group, main fluid (dextrose, amino acids, lipid) treatment group and dextrose treatment group. Nearly all patients had cancer, mainly gastric cancer(67.5%). 78% of patients were categorized well nourished and 17% of them were mildly malnourished, TPN treatment group had a significant lesser weight loss(p=0.034) than the others. Although it is not a significant difference, TPN treatment group had more infectious complications such as pneumonia, abdominal abscess while the other groups had more noninfectious complications-ileus, anastomotic leakage, hepatic dysfunction, atelectasis. Hospital stay was longer in TPN treatment group supposedly due to postoperative infectious complications. For safe and effective nutrition, systemic nutrition assessment are essential and adequate prospective studies are required for numerous patients.
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