Title Primjena postoperativne enteralne prehrane Title (english) Postoperative enteral nutrition Author Katarina Žužić Mentor Daniela Bandić Pavlović (mentor)Committee member Mladen Perić (predsjednik povjerenstva)Committee member DINKO TONKOVIĆ (član povjerenstva)Committee member Daniela Bandić Pavlović (član povjerenstva)Granter University of Zagreb Defense date and country 2016-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Enteralna prehrana predstavlja unos hrane i/ili komercijalnih nutritivnih otopina putem hranidbenih sondi u želudac, dvanaesnik ili jejunum. Danas se sve više naglašava njena važnost za što bolji i brži oporavak pacijenata nakon operacije. Stara je dogma da pacijenti poslije operacija probavnog sustava ne smiju primati ništa na usta jer se tako poboljšava cijeljenje anastomoze i da probavni trakt nije u funkciji do pojave prvih zvukova peristaltike. Suprotno tome, dokazano je da je postoperativna primjena enteralne prehrane u prva 24 sata od operacije sigurna i čak pozitivno utječe na cijeljenje anastomoze, a funkcija gastrointestinalnog trakta vraća se ubrzo nakon operacije čak i u odsutnosti peristaltike. Također, enteralna prehrana sprječava translokaciju bakterija. U početku ovog rada upoznajemo se s terminom enteralne prehrane, njenim počecima, načinima primjene i vrstama pripravaka. Nadalje objašnjavamo važnost enteralnog puta primjene i koje su prednosti u odnosu na parenteralni put. Govorimo i o indikacijama, kontraindikacijama, kao i komplikacijama primjene enteralne prehrane. U idućim odlomcima navodimo važnost procjene stanja uhranjenosti kirurških pacijenata, kako pothranjenost može biti povezana s lošijim postoperativnim ishodima i koje su metode procjene nutritivnog statusa. Također govorimo o odgovoru tijela na kiruršku traumu koji može štetno utjecati na ishod. Svi ti negativni aspekti mogu se korigirati i ublažiti primjenom enteralne prehrane. Razvitak enteralne prehrane napreduje i u primjeni se javljaju pripravci pojačani imunonutrijentima koji dodatno moduliraju imunološki i metabolički odgovor koji se javlja uslijed stresa povezanog uz kiruršku traumu. Stoga nudimo pregled djelovanja glavnih imunonutrijenata i njihove primjene u kliničkoj praksi. Pri kraju rada sažimamo trenutne smjernice o enteralnoj prehrani i podatke iz literature koji govore o njenoj primjeni u kirurgiji probavnog sustava: resekcijama jednjaka, gastrektomijama, kirurgiji pankreasa, zatim kirurgiji donjeg dijela probavnog sustava te primjeni nakon transplantacije jetre. Zaključno, nema sumnje u sigurnost primjene postoperativne enteralne prehrane. Štoviše, njena se primjena pokazala korisnom u usporedbi s parenteralnom ili nikakvom nutritivnom potporom. Smanjuje stopu postoperativnih komplikacija, ponajprije infektivnih, skraćuje boravak u bolnici i naposljetku, smanjuje troškove liječenja.
Abstract (english) The enteral nutrition involves food intake or commercial nutritional solutions intake via
feeding tubes into stomach, duodenum or jejunum.
Today, there is an emphasis on the importance of enteral nutrition for the patient's optimal
recovery after surgery. The old dogma says that patients should not receive anything by
mouth after gastrointestinal surgery because it improves anastomosis healing. It also says
that gastrointestinal tract does not return its function until the bowel sounds are positive.
Unlike this, it has been proven that the use of enteral nutrition in the first 24 hours after
surgery is safe and even has positive effects on anastomosis healing, and gastrointestinal
tract function returns soon after surgery, even in the absence of peristalsis. Enteral nutrition
prevents bacteria translocation as well.
In the beginning of the thesis the term of enteral nutrition is introduced, its beginnings, the
ways of administration and types of formulas.
Next, the importance of the enteral route of administration and its advantages comparing to
parenteral nutrition are explained. Also, indications, contraindications, as well as
complications of the use of enteral nutrition are discussed.
In the next two chapters the importance of nutritional assessment of surgical patients is
suggested. The association of malnutrition and adverse postoperative outcomes is explained
and the methods of nutritional risk assessment are mentioned. Then, the body response to
surgical trauma which may adversely affect the outcome is dealt with. All those negative
aspects may be corrected or mitigated with the use of enteral nutrition.
The development of enteral nutrition has been improved and nowadays there is the use of
immunoenhanced formulas which additionally modulate immune and metabolic stress
response related to surgical trauma. Therefore, we offer the review of the main
immunonutrients activity and its use in clinical practice.
In the end of the thesis current guidelines on enteral nutrition and information from the
literature which refer to its use in the gastrointestinal surgery are summarized: esophagus
resections, gastrectomies, pancreas surgery, lower gastrointestinal tract surgery and the use
after liver transplantation.
In the conclusion, the safety of the use of postoperative enteral nutrition is indisputable.
Moreover, it has shown the benefits compared to parenteral nutrition or conditions without
nutritional support. It decreases the postoperative complications rate, primarily the infectious
ones, it reduces the length of hospital stay and, ultimately, it reduces the treatment costs.
Keywords
enteralna prehrana
postoperativna prehrana
imunonutricija
Keywords (english)
enteral nutrition
postoperative nutrition
immunonutrition
Language croatian URN:NBN urn:nbn:hr:105:605188 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-06-29 07:33:17
