the role of the enteral route and the composition of feeds in the nutritional support of malnourished surgical patients肠内的角色路线和饲料的成分在营养不良的手术患者的营养支持.pdfVIP

Nutrients 2012, 4, 1230-1236; doi:10.3390/nu4091230 OPEN ACCESS nutrients ISSN 2072-6643 /journal/nutrients Review The Role of the Enteral Route and the Composition of Feeds in the Nutritional Support of Malnourished Surgical Patients Luca Nespoli, Sara Coppola and Luca Gianotti * Department of Surgery, Milano-Bicocca University, San Gerardo Hospital, Monza, 20900, Italy; E-Mails: luca.nespoli@unimib.it (L.N.); sara-cop@libero.it (S.C.) * Author to whom correspondence should be addressed; E-Mail: luca.gianotti@unimib.it; Tel.: +39-039-2332391; Fax: +39-039-2333652. Received: 24 July 2012; in revised form: 21 August 2012 / Accepted: 27 August 2012 / Published: 5 September 2012 Abstract: In surgical patients, malnutrition is an important risk factor for post-operative complications. In undernourished patients undergoing major gastrointestinal procedures, preoperative enteral nutrition (EN) should be preferred whenever feasible. It may be given either orally or by feeding tubes, depending on patient compliance. Early oral intake after surgery should be encouraged, but if an insufficient postoperative oral intake is anticipated, tube feeding should be initiated as soon as possible. The use of immunomodulating formulas offers significant advantages when compared to standard feeds and the positive results on postoperative complications seem independent from the baseline nutritional status. In malnourished patients, the optimal timing and dose of immunonutr