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題名 | 全靜脈營養與重大腹部手術病患術後住院日數的相關因子探討=The Effect of Total Parenteral Nutrition and other Factors on the Length of Postoperative Hosptial Stay after Major Gastrointestinal Surgery |
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作者 | 黃淑俐; 丁冠玉; 黃元惠; | 書刊名 | 臺灣營養學會雜誌 |
卷期 | 31:3 民95.09 |
頁次 | 頁87-94 |
分類號 | 416.351 |
關鍵詞 | 住院日數; 營養危險指標; 術後合併症; 全靜脈營養支持; 腸道攝食量不足; Length of hospital stay; LOS; Nutritional risk index; NRI; Postoperative complication; Total parenteral nutrition; TPN; Inadequate intake from enteral nutrition; |
語文 | 中文(Chinese) |
中文摘要 | 本研究目的為探討重大腹部手術病患,使用全靜脈營養及其他相關因子對術後住院日數的影響。研究對象為行政院衛生署新竹醫院,於民國93年接受重大腹部手術的病人100名,以回顧性的方法,探討影響術後住院日數的因素包括年齡、手術部位、惡性腫瘤、術前營養危險指標、術後合併症、全靜脈營養、術後禁食的日數、術後腸道攝食量不足的日數。結果顯示:年齡、手術部位、是否為惡性腫瘤與術後住院日數無關。術後有合併症病人(n=41)的術後住院日數,較術後無合併症的病人(n=59)顯著增加(35.2±22.2天vs 15.4±5.9天,p<0.01)。術後使用全靜脈營養的病人,住院日數顯著多於未使用者(31.1±21.6天 vs 16.0±7.6天,p<0.01)。術後有合併症又使用全靜脈營養的病人,平均術後住院日數最久(39.8±23.3天)。術後住院日數與營養危險指標呈顯著負相關(r=-0.295, p<0.001),與術後禁食日數(r=0.536, p<0.001)、術後腸道攝食量不足的日數(r=0.897, p<0.001),呈顯著正相關。本研究證實術前嚴重營養不良增加術後合併症,術後合併症造成術後腸道攝食量不足,而術後腸道攝食量不足是影響術後住院日數的最主要因子,全靜脈營養支持只是因應腸道功能不良的對策。因此建議對於接受重大腹部手術的病患,應實施初入院時的營養篩選與定期的飲食評估,予以適時的營養介入。 |
英文摘要 | We evaluated the effect of total parenteral nutrition and other factors on the length of hospital stay (LOS) after a major gastrointestinal surgery. In a retrospective study of 100 adult patients in Hsin-Chu General Hospital, the effect of various factors on LOS-suoh as age, site of surgery, the presence or absence of malignancy, preoperative nutrition risk index (NRI), postoperative complications, use of total parenteral nutrition (TPN) support, the day of beginning enteral feeding after surgery, and the period of inadequate intake from enteral nutrition were determined. The results revealed that age, site of surgery, and malignancy had no effect on LOS. However, the LOS was markedly prolonged in patients with compared to those without postoperative complications (35.2±22.2 vs. 15.4±5.9 days) and postoperative TPN support compared with those who did not (31.1±21.6 vs. 16.0±7.6 days). Patients were then grouped into those who received (n=50) and who did not receive (n=50) TPN support. A significantly extended LOS was found for patients with preoperative malnutrition (n=17; 29.7±17.9 days) or postoperative complications (n=30; 39.8±23.3 days) or both (n=12; 34.1±18.9 days) in the TPN support group. The LOS significantly correlated with the NRI (r=-0.295, p <0.01), the day of beginning enteral feeding after surgery (r=0.536, p<0.01), and the period of inadequate intake from enteral nutrition (r=0.897, p<0.01). The period of inadequate intake from enteral nutrition, the days of beginning enteral feeding after surgery and use of TPN support account for most of the variation (R^2 = 0.824) of the effect on LOS in a stepwise regression model. Gastrointestinal dysfunction resulting from postoperative complications was the main cause of prolonged LOS. Therefore, it is recommended that nutrition screening should be undertaken during hospital admission to determine nutritional risk, and dietary assessment should be carried out after surgery. |
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