Perioperative Ernährung

Zusammenfassung

Neben dem zeitlosen Anspruch an eine Minimierung der Komplikationsrate und der Morbidität liegt der Fokus beim chirurgischen Patienten heute auf der möglichst raschen postoperativen Rekonvaleszenz zur Senkung der Krankenhausverweildauer. Auch in den neuen ERAS- und Fast-Track-Konzepten (ERAS: Enhanced Recovery After Surgery) bleibt die Ernährung ein integraler Bestandteil des perioperativen Managements. Mit dem primären Ziel die Indikation zur künstlichen Ernährung zu vermeiden, ist die Erkennung, Beobachtung und frühzeitige orale Behandlung von mangelernährten Patienten mit metabolischem Risiko essenziell. Bei erwartungsgemäß ungenügender oraler Nahrungszufuhr sollte bei solchen Patienten frühzeitig mit der künstlichen Ernährung möglichst enteral, evtl. in Kombination mit einer parenteralen Ernährung begonnen werden. Die vollständige, vor allem längerfristige parenterale Ernährung bleibt nur sehr wenigen Indikationen vorbehalten. Die gezielte leitlinienbasierte Ernährungstherapie ist ein hocheffektiver auch ökonomisch relevanter Beitrag, um die perioperative Morbidität und Letalität zu senken. Für chirurgische Patienten stehen derzeit in Überarbeitung befindliche Leitlinienempfehlungen der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) (www.dgem.de, www.awmf.org) und der Europäischen Gesellschaft für Klinische Ernährung und Stoffwechsel (ESPEN) (www.espen.org) aus den Jahren 2006 und 2009 zur Verfügung.

Abstract

Next to minimizing complication rate and morbidity, enhanced recovery after surgery (ERAS) has become the focus of perioperative management. The recent ERAS (Enhanced Recovery After Surgery) and Fast Track concepts particularly emphasize the necessity of appropriate perioperative nutritional and metabolic care. Whenever possible, artificial nutritional support should be avoided. Therefore, early detection, observation, and adequate oral treatment of patients with nutritional risk remain an essential part of perioperative management. In risk patients, nutritional support should be started early and primarily via the enteral route, or in combination with parenteral nutrition. Long-term total parenteral nutrition will be limited to special indications. Individually calculated nutritional support is a clinically and economically highly effective support in order to reduce perioperative morbidity and mortality. This review includes the recent guideline recommendations for surgical patients of the German Society for Nutritional Medicine (DGEM) (www.dgem.de; www.awmf.org) and the European Society for Clinical Nutrition and Metabolism (ESPEN) (www.espen.org) from 2006 and 2009.

Schlüsselwörter

perioperative Ernährung - enterale Ernährung - parenterale Ernährung - metabolisches Risiko - Fast Track

Keywords

perioperative nutritional support - enteral nutrition - parenteral nutrition - nutritional risk - ERAS

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