本論文主要探討營養不良風險腹部手術病人的手術期間積極營養照護。研究針對有添加微量元素（TE）、多種維生素（MTV）與脂肪乳劑的周邊靜脈營養營養（PPN）配方在手術前的使用效益；評估近端空腸切除而無法馬上吻合的病人接受近端空腸造口的排出物(PJO)，重新回灌入遠端小腸的可行性與好處；以及對於營養不良風險之外科病人餵食二胜肽和三胜肽腸道營養品的臨床效益研究。
大腸癌病人手術前已有高營養不良風險的病患，除了儘量給予腸道營養，搭配較低熱量的PPN添加TE、MTV與脂肪乳劑來觀察病人的發炎症反應和預後以及評估術前營養支持的可行性。結果顯示此改良的PPN（平均使用5~6天）除了不需使用中心靜脈導管（CVC），避免傳統使用全靜脈營養（TPN）的風險（如，氣胸、血胸）以外，使用改良PPN的病人的術後發炎反應、腸道手術吻合情形、白蛋白濃度、住院天數、感染率有優於未進行PPN支持的病人，也優於有使用PPN但未添加TE與MTV組。結論：PPN添加了脂肪乳劑、MTV和TE提供方便有效且更容易執行的術前營養支持。
術前有營養不良風險的腸道手術病人由於術後無法有效腸道營養，其積極持續靜脈營養(PN)是必需的，但是對於接受近端空腸切除而無法馬上吻合的病人而需要將近端的空腸外化（exteriorization）形成造口，這些病人通常有因造口液體的高排出量而造成有短腸症的問題。PJO包含豐富的酶和電解質，因此，PJO重新回灌入遠端小腸來維持體內生理的平衡是一條可行途徑，並且評估是否能避免長期依賴PN的問題。病人在手術後PN支持立即開始，當患者開始腸內營養，我們開始了PJO回灌遠端小腸。回灌的技巧需訓練由病人及其照顧者進行，出院後繼續進行。如果可以穩定地進行PJO回灌，PN就停止。結果顯示，病人近端空腸的平均長度為20公分，遠端小腸為77.5公分，6名病人當中3名出院後不需要居家靜脈營養(Home PN);他們只住院期間需要PN。四名病人6-7個月後成功地進行小腸吻合術，沒有任何營養或代謝並發症。結論：針對此短腸症病人，足夠小腸的長度和結腸，進行近端PJO回灌進入遠端小腸可避免長期的PN。
重症病人通常有腸道營養吸收或排空不良的情形。研究證明，二胜肽和三胜肽是蛋白質的被消化的主要產物。但是，對於二胜肽和三胜肽腸道營養品的臨床效益研究非常少。這項研究比較了二胜肽和三胜肽為基礎的腸道配方（PEF）與一般完整蛋白質腸道配方（WPF），在兩組腹部手術病人的耐受性和營養狀況。72位成年加護病房（ICU）的營養不良病人納入研究。病人被分為兩組（WPF組= 40例，PEF組= 32名患者）。該研究的病人餵養至少需餵食配方7天，並且至少3天的餵食量需≥1000mL。結果顯示，PEF組在術後 (POD) 第10天的白蛋白，在POD-5和POD-10前白蛋白數值顯著高於WPF， POD-5的總淋巴細胞計數，PEF也顯著高於WPF組。ICU平均最高胃殘留量的測定，PEF組顯著低於WPF組的病人。結論，PEF配方可能比WPF配方耐受性更好。

Malnutrition has been recognized as a significant risk factor for the post operated patients, especially for those patients undergoing abdominal operations. This research is mainly aimed aggressive perioperative nutrition care for malnutrition risk abdominal surgery patients. The purposes of the study were to investigate the application of modified peripheral parenteral nutrition (PPN) support, to evaluate the influence of proximal jejunostomy output (PJO) reinfusion into the distal small bowel for short bowel syndrome (SBS) patients, and to compare the tolerance and nutritional outcomes between the dipeptide- and tripeptide-based enteral formula and a standard enteral formula in abdominal surgery patients.
Preoperative nutritional support should be given after the nutritional assessment of the patient is admitted. Patients are confirmed malnutrition can start receiving nutritional support, and most of the studies of this period of preoperative nutritional support advocated in 7 to 10 days by use total parenteral nutrition (TPN). The results of this study indicated that the time frame for hypo-calories with multiple vitamins (MTV), trace elements (TE) and fat emulsion of preoperative PPN support is merely 5.6 ± 2.6 days, shorter than previous studies, which is about 7-10 days and can significantly improve postoperative prognosis. It is critical to shorten the waiting for the surgery to reduce patients discomfort and reduce the complication rate, as well as lower postoperative inflammatory responses and better prognosis. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support.
Patients suffering from proximal jejunum perforation had better to avoid primary anastomosis and require exteriorization of proximal jejunum. These patients usually have major problems with short bowel due to the high output of the stoma. The output of a proximal jejunostomy contains abundant amounts of enzymes and electrolytes. Therefore, it is a feasible approach to re-infuse jejunostomy output to regain homeostasis. Parenteral nutrition (PN) was initiated immediately after surgery. When patients started enteral nutrition, we started the proximal jejunostomy output reinfusion protocol. Proximal jejunostomy output reinfusion was performed by the patients, and continued by them after discharge. When proximal jejunostomy output reinfusion could be performed stably, PN was stopped. The study showed the median length of the proximal jejunum was 20 cm and of the distal small bowel was 77.5 cm in patients who could stably receive proximal jejunostomy output reinfusion alone. Three patients did not require home PN; they only required PN during hospitalization. Four patients successfully underwent stoma takedown with intestinal anastomosis after 6–7 months without any nutritional or metabolic complications. In conclusion, short bowel syndrome patients with an adequate length of small bowel and functional colon could avoid long-term PN by receiving reinfusion of proximal jejunostomy output into the distal small bowel.
Enteral nutrition is a preferred means of support for stimulating gut hormones, modulating immunity, and maintaining the barrier function of the intestinal mucosa. However, malabsorption, poor emptying, and hypoalbuminemia often occur in patients given enteral nutrition. Studies have demonstrated that dipeptides and tripeptides are the major products of proteins that are digested. Few clinical trials, however, have investigated the clinical benefits of dipeptide- and tripeptide-based enteral formulas. We compared a dipeptide- and tripeptide-based enteral formula with a standard enteral formula for tolerance and nutritional outcomes in abdominal surgery patients. A retrospective study design was used to assess the differences between a whole-protein formula (WPF) and a dipeptide- and tripeptide-based formula (PEF) in clinical outcomes. Seventy-two adult intensive care unit patients with serum albumin concentrations less than 3.0 g/dL were enrolled in this study. Intervention: Patients were divided into two groups (WPF group = 40 patients, PEF group = 32 patients). The study patients were fed for at least 7 days, with ≥ 1000 mL of enteral formula infused on at least 3 of the days. The results showed the mean serum albumin level on postoperative day (POD) 10, prealbumin levels on POD-5 and POD-10, and total lymphocyte count on POD-5 were significantly higher for the PEF group compared to those for the WPF group (P <0.05). The average maximum gastric residual volume of the PEF patients during their intensive care unit (ICU) stays was significantly lower than that for WPF patients. In conclusions, the dipeptide- and tripeptide-based enteral formulas are more efficacious and better tolerated than whole-protein formulas.

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