营养支持治疗在老年外科患者围手术期应用价值的研究

Research on the Application Value of Nutritional Support Therapy in the Perioperative Period of Elderly Surgical Patients

摘要: 随着人口老龄化加速，接受外科手术的老年患者比例显著增加。老年患者常伴有营养不良、衰弱及肌少症，使其围手术期风险倍增。自外科实践开始以来，减少术后并发症和早期恢复一直是推动手术技术和围手术期管理进步的两大根本支柱。尽管在这些领域取得了巨大的进步，抗生素预防的合理化，以及其他重要的创新，但术后恢复(特别是老年患者，肿瘤病理或消化或头颈部手术)是曲折的。这可以用几个原因来解释，其中，营养不良起着主要作用。围手术期营养支持，包括在ERAS (术后增强恢复)方案中，已被证明是实现更好手术效果的主要元素和关键步骤。从择期手术的术前营养评估和治疗开始，我们可以通过口服补品和免疫调节配方来改善营养状况。如果我们在术后情况下增加早期营养支持，我们就能够显著减少感染并发症、重症监护病房(ICU)需求和住院时间、费用和死亡率。在接受手术的老年人中，营养不良尤其令人担忧，营养不良或有营养不良风险是术后并发症、再入院率增加和心血管不良预后的重要危险因素，在这一人群中普遍存在的合并症以及随后的功能和认知状态下降突出了最佳围手术期营养的重要性。本文综述老年外科患者的营养风险特征，围手术期营养支持(包括术前筛查与评估、术前预康复、术中维护及术后强化)的应用策略与具体价值，旨在为临床实践提供参考。

Abstract: With the acceleration of population aging, the proportion of elderly patients undergoing surgical procedures has significantly increased. Elderly patients often suffer from malnutrition, frailty and sarcopenia, which doubles their perioperative risks. Since the beginning of surgical practice, reducing postoperative complications and achieving early recovery have been two fundamental pillars driving the progress of surgical techniques and perioperative management. Although significant progress has been made in these areas, the rationalization of antibiotic prophylaxis and other important innovations, the postoperative recovery (especially for elderly patients, those with tumor pathology or digestive or head and neck surgery) is a tortuous process. This can be explained by several reasons, among which malnutrition plays a major role. Perioperative nutritional support, including in the ERAS (Enhanced Recovery After Surgery) protocol, has been proven to be a main element and key step for achieving better surgical outcomes. Starting from preoperative nutritional assessment and treatment for elective surgeries, we can improve the nutritional status through oral supplements and immune-regulating formulas. If we increase early nutritional support in the postoperative situation, we can significantly reduce infection complications, the need for intensive care units (ICUs), hospital stays, costs and mortality. In elderly patients undergoing surgery, malnutrition is particularly worrying. Malnutrition or the risk of malnutrition is an important risk factor for postoperative complications, increased readmission rates, and adverse cardiovascular outcomes. The prevalent comorbidities and subsequent functional and cognitive decline in this population highlight the importance of optimal perioperative nutrition. This article reviews the nutritional risk characteristics of elderly surgical patients, the application strategies and specific values of perioperative nutritional support (including preoperative screening and assessment, preoperative rehabilitation, intraoperative maintenance and postoperative intensification), with the aim of providing a reference for clinical practice.