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DOI: 10.1055/s-0028-1090143
© Georg Thieme Verlag KG Stuttgart · New York
Perioperative Ernährung – Metabolische Konditionierung
Perioperative Nutrition – Metabolic ConditioningPublication History
Publication Date:
09 March 2009 (online)
Zusammenfassung
Ein operativer Eingriff zieht eine Serie an Stressreaktionen des Körpers nach sich. Stresshormone und Zytokine führen zur Katabolie von Glykogen, Fett und Proteinen. Der Anstieg von Blutglukose und die Freisetzung von freien Fett- und Aminosäuren liefern kompensatorisch die nötigen Substrate für die Bewältigung der durch das chirurgische Trauma entstandenen Aufgaben wie Wundheilung und Immunantwort. Mit andauernder Stressantwort entsteht ein Mangel an Substraten für das Sichern der normalen Stoffwechselvorgänge wie körperliche Aktivität. Für eine optimale Rehabilitation jedoch benötigt der Körper einen anabolen Metabolismus. Zahlreiche Studien konnten zeigen, dass Bündel an Maßnahmen zur Stressreduktion die katabolischen Reaktionen reduzieren, eine anabole Stoffwechsellage stimulieren und stützen und so selbst nach großen chirurgischen Eingriffen zu einer besseren und schnelleren Genesung der Patienten führen. Diese sogenannten „Enhanced Recovery After Surgery” (ERAS)-Konzepte konzentrieren sich neben einer verbesserten präoperativen Vorbereitung, Anästhesie, Analgesie und frühen Mobilisierung auch auf eine Optimierung der perioperativen nutritiven Substratzufuhr. Dazu gehören eine verkürzte präoperative Nahrungskarenz, kurzfristig vor Anästhesie zugeführte kohlenhydratreiche Trinknahrungen, eine möglichst sofortige Fortführung der Nahrungsaufnahme nach der Operation sowie der perioperative Zusatz von Nahrungsergänzungsmitteln. Diese ernährungsmedizinischen Maßnahmen konnten in Studien eine Stabilisierung des Organismus erreichen, insofern als der postoperativen Insulinresistenz vorgebeugt, Proteinkatabolismus minimiert, oxidativer Stress reduziert und verschiedene Organfunktionen verbessert wurden. Diese Maßnahmen waren assoziiert mit einem verbesserten perioperativen Wohlbefinden, geringerem postoperativen Muskelschwund und verbesserter Muskelkraft, einer Reduktion postoperativer Komplikationen sowie einer verkürzten intensivstationären und Krankenhausbehandlungszeit.
Abstract
Surgery elicits a series of metabolic stress reactions. Stress hormones and inflammatory mediators (i. e. cytokines) cause catabolism of glycogen, lipids and proteins. Glucose, free fatty acids, and amino acids are released for the tasks of healing and immune response. Thus, substrates are diverted from normal purposes such as physical activity. However, the patient requires anabolic metabolism to reach optimal recovery. Many stress-reducing measures have proven to minimize catabolism and support anabolism, and have led to faster and better rehabilitation, even after major surgical trauma. The so-called „Enhanced Recovery After Surgery” (ERAS) concepts focus on better preoperative preparation, anaesthesia, analgesia, and early mobilisation as well as improved supplies of nutritional substrates. This includes generally reduced preoperative fasting, preoperative carbohydrate loading, no interruption of oral nutritional intake after surgery, if possible, and a perioperative consumption of oral nutritional supplements. Studies have shown that such nutritional practices contribute to perioperative stabilisation of the organism by reducing postoperative insulin resistance, minimising protein catabolism, decreasing oxidative stress, and improving various organ functions. Further consequences are improved perioperative condition, attenuated depletion of muscle mass, reduction of postoperative complications, and reduced intensive care unit and hospital stays.
Schlüsselwörter
„Fast-track”-Chirurgie - präoperative Konditionierung - Mangelernährung - präoperative Kohlenhydratzufuhr - perioperative Ernährungsrezepte
Key words
fast track surgery - preoperative optimization - malnourishment - preoperative carbohydrate loading - perioperative concepts of nutrition
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Dr. Jan-Philipp Breuer
Centrum 7 für Anästhesiologie, Intensivmedizin und OP-Management, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin
Phone: 030/450 531 052
Fax: 030/450 531 911
Email: philipp.breuer@charite.de