Cengizhan EMRE, Cihan DÖĞER, İlhami DEMİRKAPU, Dilşen ÖRNEK, Kadriye KAHVECİ, Semih AYDEMİR, Gözde Bumin AYDIN

Geriatrik, beslenme bozukluğu bulunan ve riskli cerrahi için hazırlanan hastada nütrisyonun önemi: Olgu sunumu

Kardiyak cerrahi gibi major cerrahiye alınan hastalarda cerrahi strese bağlı olarak protein ve enerji ihtiyacında artış gözlenir. Bu tip major operasyonlar geriyatrik ve malnûtrisyonlu hastalarda kritik önem arz eder. Bu olgu sunumunda 68 yaşında ileri derece trikiispit ve mitral yetmezliği, orta derece aort yetmezliği bulunan genel durumu bozuk kadın hastanın kapak replasman operasyonuna alınabilmesi ve postoperatif iyileşme sürecinin hızlanabilmesi için uyguladığımız yoğun bakım beslenme protokolü sunulmaktadır. Olgu: Hasta operasyondan 7 gün önce değerlendirildi ve Harris Benedict formülüne göre günlük 1219 kcal beslenme alması gerekliği tespit edildi. Hasta diyetle bu kalorinin 113 ünden azını alabiliyordu. Bu durumda hastanın diyetine ek olarak ensure plus 3x375 kcal ara öğünlerde verildi ve gerekli kcal ihtiyacı sağlandı. Postoperatif ikinci giin 1200 kcal parenteral besleme haşlanan hasta 5. gün ekstiibe edildi. Enteral beslenmesinde 1341 kcal alması gereken hastanın ihtiyacını alamaması nedeniyle perative 3.x325 kcal yoğun bakım beslenme iiıiinü diyetine eklendi. Yoğun bakımda takibinin 12. gününde hasta servise çıkarıldı. Servis takibinde vital bulgularının stabil seyrettiği gözlendiğinden postoperatif 14.gününde taburcu edildi. Geriatrik, beslenme bozukluğu olan ve riskli operayonlara girecek olan hastalara preoperalif başlanan beslenme desteği intraoperatif ve postoperatif vital bulguların daha stabil seyretmesine katkı sağlayabilir.

The importance of nutrition in geriatric patients with high risk against surgery: A case report

Introduction: In patients undergoing major surgery like cardiovascular surgery, the need for protein and energy increase due to surgical stress. Moreover geriatric patients with malnutrition undergoing these major surgeries constitute high risk groups. In this case report we present the nutrition protocol in intensive care unit in order to improve the healing process of a 68- year old woman with significant tricuspid and mitrale valve failure, and moderate aortic valve failure, who was scheduled for valve replacement operation. Case: Patient was assessed 7 days before the operation and a nutrition plan for 1219 kcal per day due to Harris Benedict formula was set. The patient could take less than 1/3 of these calories due to his diet. In addition his diet, ensure plus 250cc (375 kcal) 3 times daily between main meals was given in order to provide for his required kcal need. Parenteral nutrition with 1200 kcal was started 2 days after the operation, and the patient was extubated on 5th postoperative day. Due to the inability to obtain 1341 kcal which was necessary for enteral feeding, perative 3x325 kcal intensive care nutrition product was added to the diet. The patient was transferred to ward on postoperative 12th day. During the follow-up, vital signs were stable and the patient was discharged with good recovery on postoperative 14th day. Preoperative nutrition support may contribute to the stabilization of intraoperative and postoperative vital signs in patients with high risk.

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