대한지역사회영양학회지 (Korean Journal of Community Nutrition)

대한지역사회영양학회 (The Korean Society of Community Nutrition)
권호 표지

경장영양과 중시정맥영양을 공급받는 외과계 수술 환자의 과대사 정도에 따른 영양 섭취량 및 생화학적 검사 결과

The Outcome of Nutrition Support of Surgery Patients with Hypermetabolic Severity by Total Parenteral Nutrition and Enteral Nutrition and Biochemical Data

  • 라미용 (삼성서울병원 영양파트) ;
  • 김은미 (삼성서울병원 영양파트) ;
  • 조영연 (삼성서울병원 영양파트) ;
  • 서정민 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 최혜미 (서울대학교 식품영양학과)
  • Rha Mi-Yong (Department of Dietetics, Samsung Medical Center) ;
  • Kim Eun-Mi (Department of Dietetics, Samsung Medical Center) ;
  • Cho Young-Y. (Department of Dietetics, Samsung Medical Center) ;
  • Seo Jeong-Meen (Department of Surgery, Samsung Medical Center, SungkyunKwan University School of Medicine) ;
  • Choi Hay-Mie (Department of Food and Nutrition, Seoul National University)
  • 발행 : 2006.04.01
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초록

This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever ($>38^{\circ}C$), rapid breathing (>30 breaths/min), rapid pulse rate (>100 beats/min) , leukocytosis ($WBC>12,000/{\mu}l$), leukocytopenia ($WBC>3,000/{\mu}l$), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.

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