第一节 围术期.doc

第一节 围手术期 ? 　　The majority of elective surgical patients have a normal nutritional status and normal metabolism prior to surgery and usually the surgery is of minor or moderate extent. These patients can eat and should be given normal hospital food as soon as possible after the operation.　　A much smaller group of surgical patients are malnourished. These patients have a higher risk of mortality, complications, prolonged hospital stay, and delayed rehabilitation and convalescence. Because of the risks associated with malnutrition and surgery, all patients about to undergo surgery should be screened and assessed for nutritional status. Those with severe malnutrition should be considered for artificial perioperative nutritional support.　　 一、概述　　Perioperative period is deemed that the time from the assured operation cure, until the correlative cures about the operation basically end, which includes the preoperative phase, intraoperative phase and postoperative phase. 　　围手术期（perioperative period）是指从确定手术治疗时起，直到与这次手术有关的治疗基本结束为止，包含手术前、手术中及手术后的一段时间。围手术期一词最初见于20世纪70年代国外文献，以后国内也开始陆续使用，但对其所包含的确切时间范围尚无一个明确的界定。由于围手术期的长短因手术不同而异，故没有特别明确的时限，一般为术前5～7天至术后7～12天。　　手术是一种创伤性治疗手段，手术的创伤可以引起机体一系列内分泌和代谢变化，导致体内营养物质消耗增加、营养状况水平下降及免疫功能受损。营养不良是外科住院病人中的普遍现象。营养不良，可导致病人对手术的耐受力下降，手术后容易发生感染、切口愈合延迟等并发症，影响预后。外科死亡病例中，由营养不良直接或间接引起者可达30%。　　病人手术后能否顺利康复，机体营养储备状况是重要影响因素之一。通过合理补充营养物质改善围手术期病人的营养状况，对于提高病人手术耐受力、减少并发症、促进术后恢复有着十分重要的意义。　　 二、营养代谢特点　　The emergent response of the perioperative period patient manifests the synthetic changes of the pathology and physiology which are caused by the nerve incretion. Those changes include the flock of hepatin and inositol decompose the glucose into the blood, consequently results in the high blood sugar and even the urine sugar, which aims to satisfy the emergent need of tissue and cell, such as the cerebrum, the leukocyte, the red blood cell, the lick-up cell and the kidney medulla. The second change is that the protein of the out liver, mainly the skeleton muscle