CLINICAL APPLICATION OF EARLY POSTOPERATIVE NUTRITIONAL SUPPORT IN PATIENTS WITH HIGH-RISK VALVULAR HEART DISEASE.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2024-10-01 Epub Date: 2024-08-14 DOI:10.1097/SHK.0000000000002436

Xiangyang Xu, Boyao Zhang, Mengwei Tan, Xingli Fan, Qian Chen, Zhiyun Xu, Yangfeng Tang, Lin Han

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Abstract

Abstract: Background : The treatment strategy of early nutritional support after cardiac surgery has gradually been adopted. However, there are no scientific guidelines for the timing and specific programs of early nutritional support. Methods: A retrospective, single-center analysis (2021-2023) was carried out including elderly patients who were admitted for valvular heart disease and received open-heart valve replacement surgery. We designated patients who started the optimized nutritional support after surgery as the optimized enteral nutritional support strategy TN (EN) group and those who received traditional nutritional support as the traditional nutritional support strategy (TN) group. The nutritional and immune indexes, postoperative complications, length of hospital stay, and hospitalization cost of the two groups were compared and analyzed. Results: We identified 378 eligible patients, comprising 193 (51%) patients in the EN group and 185 (49%) patients in the TN group. There was no significant difference in hospital mortality between the two groups, but the proportion of nosocomial pneumonia was significantly lower in the EN group than in the TN group ( P < 0.001). In the Poisson regression analysis, EN was not associated with an increase in gastrointestinal complications ( P = 0.549). The EN group also seemed to have shorter hospital stays and lower hospitalization expenses ( P < 0.001). In the comparison of postoperative gastrointestinal complications, fewer patients experienced diarrhea ( P = 0.021) and abdominal distension ( P = 0.033) in the EN group compared with the TN group. Conclusion: The optimal nutritional support strategy could effectively improve the clinical outcome of high-risk patients with valvular heart disease.

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高危瓣膜性心脏病患者术后早期营养支持的临床应用。

背景：心脏手术后早期营养支持的治疗策略已逐渐被采用。然而，早期营养支持的时机和具体方案尚无科学指南：我们对因瓣膜性心脏病（VHD）入院并接受开胸瓣膜置换手术的老年患者进行了回顾性单中心分析（2021-2023 年）。我们将术后开始接受优化营养支持的患者定为 EN 组，将接受传统营养支持的患者定为 TN 组。我们对两组患者的营养和免疫指标、术后并发症、住院时间和住院费用进行了比较和分析：我们确定了 378 名符合条件的患者，其中 EN 组 193 人（51%），TN 组 185 人（49%）。两组患者的住院死亡率无明显差异，但 EN 组的非典型肺炎比例明显低于 TN 组（P < 0.001）。在泊松回归分析中，EN组与胃肠道并发症的增加无关（P = 0.549）。EN 组的住院时间更短，住院费用更低（P < 0.001）。在术后胃肠道并发症的比较中，与 TN 组相比，EN 组出现腹泻（P = 0.021）和腹胀（P = 0.033）的患者更少：结论：最佳营养支持策略可有效改善瓣膜性心脏病高危患者的临床预后。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.