İlyas BAŞKONUŞ, Necdet AYBASTI, Avni GÖKALP, Göktürk MARALCAN, Ahmet A. BALIK, Ersin BORAZAN

Perioperatif total parenteral nutrisyonun postoperatif morbidite ve mortalite üzerine etkileri

Literatürde, ciddi malnütrisyonlu hastaların, ciddi malnütrisyonu olmayan hastalara göre postoperatif komplikasyon oranlarının daha yüksek olduğu bilinmektedir. Bu prospektif çalışmanın amacı; ciddi malnütrisyonlu gastrointestinal sistem kanserli hastalarda perioperatif beslenme tedavisinin, postoperatif morbidite ve mortalite üzerine etkilerinin araştırılmasıdır. Gastrointestinal sistem kanseri tanısı konulan 71 hasta çalışmaya alındı. Hastaların nütrisyonel durumunun değerlendirilmesi amacıyla Subjektif Globa l Değerlendirme indeksi kullanıldı. Hastalar ciddi malnütrisyonu olanlar (Grup 1) ve ciddi malnütrisyonu olmayanlar (Grup 2: hafif-orta malnütrisyonlular) şeklinde ikiye ayrıldı. Grup 1’deki 36 hastanın günlük enerji gereksinimleri hesaplandı, ortalama 30-35 kcal/kg/gün olacak şekilde preoperatif 7 gün ve postoperatif 3 gün total parenteral nütrisyon uygulandı. Grup 2’deki 35 hastaya perioperatif beslenme desteği yapılmadı. Morbidite ve mortalite takipleri hastaların hastanede yattıkları süre içerisinde yapıldı. Toplam morbidite: major, minor, total parenteral nütrisyona bağlı komplikasyonlar olarak değerlendirildi. Grup 1’de 7 hastada (%19.41), Grup 2’de 6 hastada (%17.11) majör komplikasyon görüldü (p=0.80). Toplam morbidite, Grup 1’de 16 (%44.40), Grup 2’de 17 (%48.57) olarak saptandı (p=0.727). Her iki grupta postoperatif dönemde birer adet mortalite görüldü. Bu çalışmada, ciddi malnütrisyonlu hastalarda perioperatif total parenteral nütrisyon tedavisi ile morbidite ve mortalitenin ciddi malnütrisyonu olmayan hastalardaki morbidite ve mortalite seviyesine kadar düşürülebileceği kanaatine varıldı.

The effects of perioperative total parenteral nutrition on postoperative mortality and morbidity

It is known that postoperative complication ratios at severely malnourished patients were higher than nonseverely malnourished patients according to the data in literature reviews. The goal of this prospective study is to investigate the effects of per ioperative nutritional support on postoperative morbidity and mortality in severely malnourished gastrointestinal tract cancer patients. Seventyone patients with the diagnosis of gastrointestinal tract cancer were included in this study. Subjective Global Assessment index was applied for patients’ nutritional state. The patients were divided into two groups, severely malnourished (Group 1) and nonseverely malnourished (Group 2: well-nourished and mildly malnourished). The daily energy requirement of 36 patients in Group 1 was calculated and total parenteral nutrition was applied 30-35 kcal/kg/day by average for preoperative 7 days and postoperative 3 days to these 36 patients. Perioperative total parenteral nutrition was not given to 35 patients in Group 2. Patient morbidity and mortality was followed during the hospitalization period. Total morbidity was defined as; major complications, minor complications and complications related to total parenteral nutrition. Major complications occurred in 7 patients (19.41%) in Group 1 and 6 patients (17.11%) in Group 2 (p=0.80). Total morbidity was in 16 patients (44.40%) in Group 1, and 17 patients (48.57%) in Group 2 (p=0.727). Mortality was seen as one patients in each group postoperatively. In this study, it was concluded that morbidity and mortality ratio of severely malnourished patients can be decreased to the morbidity and mortality ratio of nonseverely malnourished patients with perioperative nutrition.

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