Osman KURUKAHVECİOĞLU, Bülent SALMAN, Mehmet OĞUZ, Erhan ONUK, Ertan TATLICIOĞLU

A subjective global assessment of nutritional status: A study of 1400 surgical patients

Amaç: Bu çalışma Genel Cerrahi Kliniği'ne yatan hastaların beslenme durumlarını ve malnutrisyonu olanlara beslenme desteği vermenin etkinliğini değerlendirmek için yapıldı. Hastalar ve Yöntemi: Sübjektif Global Değerlendirme İndeksi (SGDİ) 1400 hastaya (1229 benign, 171 malign) hastaneye yatış sırasında uygulandı. İki meme kanserli ve 121 gastrointestinal sistem (GIS) kanserli hastaya enteral, parenteral veya enteral ve parenteral kombine yolla nutrisyonel destek verildi. Beslenme desteği alan hastalar nitrojen dengesi değeriyle takip edildi. Beslenme desteği operasyondan 3-5 gün önce başlandı. Birçok hastaya oral, nazoenteral veya jejunostomi yoluyla erken enteral beslenme başlandı. Beslenme desteği ortalama 10 gün sürdü. Beslenme desteği alan hastalar taburculuğu sırasında SGDİ ile tekrar değerlendirildi. Bulgular: 1229 benign hastanın, 1187'si (%96.4) A grubunda, 42'si de (%3.6) B grubunda idi. Bu hastalardan hiçbirine nutrisyonel destek yapılmadı. 50 endokrin sistem maligniteli hastadan sadece ikisi meme karsinomalı hasta C grubunda idi ve bu hastalara da enteral nutrisyonel destek yapıldı. Operasyon öncesinde 121 GIS kanserli hastanın 33'ü (%27.3) A grubu, 63'ü (%52) B grubu ve 25'i (%20.7) de C grubunda idi. Beslenme durumuna bakılmaksızın tüm GIS kanserli hastalara beslenme desteği verildi. Beslenme desteği alan hastalar taburculuğu sırasında 68'i (%55.3) aynı grupta, 4'ü (%3.3) bir alt grupta ve 51'i (%41.4) da bir üst grupta idi. Bu çalışmada hastane mortalitesi olmadı. Sonuç: Sonuç olarak benign bir hastalık nedeniyle başvuran hastaların %3.6'sı, malign bir sebeple başvuranlarında %53.8'i değişik derecelerde malnütre idi. SGDİ ile değerlendilerek verilen standart bir nutrisyonel destekle ameliyat olacak hastalarda preoperatif beslenme durumu bir üst seviyeye çıkarılabilir veya en azından korunabilir.

Subjektif global değerlendirme endeksi ile 1400 cerrahi hastanın nutrisyonel durumunun değerlendirilmesi

Purpose: The aim of this study was to evaluate the nutritional status of patients hospitalized in a surgical department and to assess the contribution of nutritional support to patients with malnutrition. Materials and Methods: A Subjective Global Assessment (SGA) was performed in 1400 patients (1229 benign and 171 malignant cases) at admission. Two patients with breast carcinoma and 121 patients with GIS malignancies had nutritional support by way of enteral, parenteral, or combined enteral and parente-ral nutrition. Urinary nitrogen excretion was used for the clinical evaluation of the patients who received nutritional support. Nutritional support was started 3-5 days prior to surgery. Most of the patients received early enteral nutritional support orally or by way of nasoenteral or jejunostomy tubes, postoperatively. The duration of nutritional support was approximately 10 days. In the group of patients who received nutritional support, the nutritional status on discharge was compared with that at admission. Results: Of the 1229 benign cases, 1187 (96.4%) were classified in group A and 42 (3.6%) were classified in group B. None of them received nutritional support. Of the 50 patients with endocrine malignancies, only the two breast carcinoma patients who scored C received nutritional support. A preoperative evaluation of the 121 patients with GI malignancies revealed that 33 (27.3%) scored A, 63 (52%) B, and 25 (20.7%) C. Nutritional support was given to all patients with GI malignancies, regardless of the nutritional status. When the 123 patients who received nutritional support were discharged, 68 of them (55.3%) were in the same group, 4 (3.3%) had deteriorated to a lower group, and 51 (41.4%) had risen to an upper group. No hospital mortality was observed in the study group. Conclusion: The results indicated that 3.6% of the surgical patients with benign and 53.8% of those with malignant diseases were malnourished to various degrees, preoperatively. Using the SGA and with a standardized strategy of nutritional support, it is possible to provide better nutritional levels or to maintain the preoperative nutritional status in patients undergoing surgery.

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