- Email: [email protected]
Parenteral and enteral nutrition in patients after extensive surgical procedures in postoperative period
AFSTRACTS FROM
THE
1OTI-I ANNUAL
MEETING
OF THE POLISH
SOCIETY
?? Raczy&ka,S., Kostro,J., Gacyk ,W. TOTAL PARENTERAL NUTRITION (TPN) IN PATIENTS AFTER PANCREATODUODENECTOMY. I Clinic of Surgery, Medical Academy in Gdtisk, Poland. The aim of this study was to evaluate the energy and protein requirement in patients after pancreatoduodenectomy. Material : In 19 adult patients pancreatic resections were performed in resections. Three 1994-1995; 16 total and 9 Whipple’s patients were in normal nutritional status, but in 10 marasmic malnutrition, in 1 kwashiorkor like malnutrition and in 5 marasmic kwashiorkor has been diagnosed. Postoperative TPN was provided in 12 patients for a period ranged from 5 up to 10 days. Cyclic TPN ( 16 h/ day) was associated with s’ignificant disturbances of serum glucose levels (hyper- or hypoglycaemia). Continuous 24 h lasting parenteral nutrition was better tolerated. The results of TPN are shown in table below:
Conclusions: Continuous TPN is necessary in patients after total pancreatectomy. These patients need about 32 kcal / kg.b.w./day and 3 g I b.w.124 h of proteins.
??Piotr Rumianowski RESULTS OF IMPLEMENTATION OF PARENTERAL NUTRITION INTO DEPARTMENT OF GENERAL SURGERY OF CITY HOSPITAL.
Department of General Surgery,City Hospital, Gdatisk, Poland. The lack of knowledge and experience is the main obstacle against introduction of modem nutritional therapy into country hospital. The aim of the study was to evaluate the results of introduction of parenteral nutrition without previous experience in this field into management of patients treated in surgical department of city hospital. Two surgeons were trained in parenteral nutrition in the Dept. of Gastroenterological Surgery in Warsaw. After coming home they developed a nutritional team. During last two years 16 patients were parenterally fed., 10 because of postoperative fistulas, 3 for severe acute pancreatitis and the remaining because of liver or renal failure. 12 patients were cured and survived, 4 died because of basic disease. The results are comparable with obtained in the university centre’s. The results show parenteral nutrition possible and successful in the small city hospital.
OF P ARENTERAL
AND
ENTERAL
NLTlNTlON
604 ??Ladny J.R., Pruszynski
K., Puchalski Z. SANDOSTATIN (OCTREOTIDE) AND TOTAL PARENTERAL NUTRITION IN THE TREATMENT OF SOME PANCREATIC DISEASES Dept. of General Surgery, Medical University of Bialystok, Poland Acute and complicated chronic pancreatitis, pancreatic fistulas, pancreatic trauma jnjures and tumors of the pancreas are indications for use of Somatostatin and its analogues. Additional therapy with total parenteral nutrition (TPN) in patients suffering from mentioned above diseases are indicated when malnutrition and cachexia occurred, caused by catabolism and diet ,,O”. Combination of Somatostatin and TNP gives more powerful suppression of pancreatic output and made possible to keep positive nitric balance. The aim of study is presentation of our experiences with use of Sandostatin (Octreotide) and TNP in the treatment of some pancreatic diseases. Between 1995 and February 1996 in the author’s Department total of 24 patients (aged 23-72 years) with pancreatic diseases were treated using Sandostatin and TNP. It were 11 cases of acute pancreatitis, 5 patients with complicated postoperative course after surgery for chronic pancreatitis (e.g. fistulas), 8 carcinomas of the pancreas. Sandostatin was administered in dose 1OOpg 3 times a day, TPN was introduced no later than 48-72 hours from the time of final diagnosis or performance of surgery. Mean time of administration of Sandostain was 7 days, TNP 7-18 days. Nitric balance was evaluated by measurement of protein and albumin concentration in serum and excretion of urea nitrogen. The mortality ratio in patients treated with Sandotatin and TNP was 8,3%, any local and general complications were observed. In all patients with pancreatic tistulas decrease of pancreatic juice output and final closure of tistulas were achieved. The results of our study indicate that combination of Sandostatin and TNP is efficient treatment of some pancreatic diseases.
??J.Kalaciriski,
A.Wojdylo, K.Kurczych, B.Kalacidska, R.BeretaKurczych. PARENTERAL AND ENTERAL NUTRITION IN PATIENTS EXTENSIVE AFTER SURGICAL PROCEDURES IN POSTOPERATIVE PERIOD. Dept.of General Surgery,Dept.of Anaesthesia and Int.Care, Dept.of Pharmacy, City Hospital, 08wiccim,Poland.
Nutritional treatment patient undergoing extensive surgical procedur& is -a condition of shortening catabolic phase of postoperative period. Giving’ a basal quantity of nutritional components, authors tried to do a clinical evaluation treated patients and possibilities of the nutritional treatment in a provincial hospital. 25 patients were divided into 3 groups: l-treated with laparostomy because of pancreatic necrosis, 2-after total gastrectomy, 3-after extensive resections of jejunum or colon with complications. Clinical status, weight loss, accessible laboratory investigations was studied. Authors gave on the average: energy 31.9 kcal/‘kg/day, protein 0.15 gN/kg/day, potassium 1.35 mq /kg/day. In 19 patients appeared weight loss 3.36 kg. In 20 patients with decreased serum protein level or blood cell count- plasma and erythrocytes were applied. In examined groups 3 persons died because of myocardial infarction, pulmonary embolism and intestinal necrosis with peritonitis. Conclusions: 1. Effective treatment of postoperative complications and low mortality must be attribute to nutritional treatment. 2. Adequate nutritional components administration should be applied intravenously, enterally or by both of them. 3. The best effects of nutrition are obtained by nutritional team cooperating with department of surgery, intensive care unit and a patient’s family. 4. Economical conditions of provincial hospitals cause important difficulties in applying of nutritional support in perioperative period.
THE
1OTI-I ANNUAL
MEETING
OF THE POLISH
SOCIETY
?? Raczy&ka,S., Kostro,J., Gacyk ,W. TOTAL PARENTERAL NUTRITION (TPN) IN PATIENTS AFTER PANCREATODUODENECTOMY. I Clinic of Surgery, Medical Academy in Gdtisk, Poland. The aim of this study was to evaluate the energy and protein requirement in patients after pancreatoduodenectomy. Material : In 19 adult patients pancreatic resections were performed in resections. Three 1994-1995; 16 total and 9 Whipple’s patients were in normal nutritional status, but in 10 marasmic malnutrition, in 1 kwashiorkor like malnutrition and in 5 marasmic kwashiorkor has been diagnosed. Postoperative TPN was provided in 12 patients for a period ranged from 5 up to 10 days. Cyclic TPN ( 16 h/ day) was associated with s’ignificant disturbances of serum glucose levels (hyper- or hypoglycaemia). Continuous 24 h lasting parenteral nutrition was better tolerated. The results of TPN are shown in table below:
Conclusions: Continuous TPN is necessary in patients after total pancreatectomy. These patients need about 32 kcal / kg.b.w./day and 3 g I b.w.124 h of proteins.
??Piotr Rumianowski RESULTS OF IMPLEMENTATION OF PARENTERAL NUTRITION INTO DEPARTMENT OF GENERAL SURGERY OF CITY HOSPITAL.
Department of General Surgery,City Hospital, Gdatisk, Poland. The lack of knowledge and experience is the main obstacle against introduction of modem nutritional therapy into country hospital. The aim of the study was to evaluate the results of introduction of parenteral nutrition without previous experience in this field into management of patients treated in surgical department of city hospital. Two surgeons were trained in parenteral nutrition in the Dept. of Gastroenterological Surgery in Warsaw. After coming home they developed a nutritional team. During last two years 16 patients were parenterally fed., 10 because of postoperative fistulas, 3 for severe acute pancreatitis and the remaining because of liver or renal failure. 12 patients were cured and survived, 4 died because of basic disease. The results are comparable with obtained in the university centre’s. The results show parenteral nutrition possible and successful in the small city hospital.
OF P ARENTERAL
AND
ENTERAL
NLTlNTlON
604 ??Ladny J.R., Pruszynski
K., Puchalski Z. SANDOSTATIN (OCTREOTIDE) AND TOTAL PARENTERAL NUTRITION IN THE TREATMENT OF SOME PANCREATIC DISEASES Dept. of General Surgery, Medical University of Bialystok, Poland Acute and complicated chronic pancreatitis, pancreatic fistulas, pancreatic trauma jnjures and tumors of the pancreas are indications for use of Somatostatin and its analogues. Additional therapy with total parenteral nutrition (TPN) in patients suffering from mentioned above diseases are indicated when malnutrition and cachexia occurred, caused by catabolism and diet ,,O”. Combination of Somatostatin and TNP gives more powerful suppression of pancreatic output and made possible to keep positive nitric balance. The aim of study is presentation of our experiences with use of Sandostatin (Octreotide) and TNP in the treatment of some pancreatic diseases. Between 1995 and February 1996 in the author’s Department total of 24 patients (aged 23-72 years) with pancreatic diseases were treated using Sandostatin and TNP. It were 11 cases of acute pancreatitis, 5 patients with complicated postoperative course after surgery for chronic pancreatitis (e.g. fistulas), 8 carcinomas of the pancreas. Sandostatin was administered in dose 1OOpg 3 times a day, TPN was introduced no later than 48-72 hours from the time of final diagnosis or performance of surgery. Mean time of administration of Sandostain was 7 days, TNP 7-18 days. Nitric balance was evaluated by measurement of protein and albumin concentration in serum and excretion of urea nitrogen. The mortality ratio in patients treated with Sandotatin and TNP was 8,3%, any local and general complications were observed. In all patients with pancreatic tistulas decrease of pancreatic juice output and final closure of tistulas were achieved. The results of our study indicate that combination of Sandostatin and TNP is efficient treatment of some pancreatic diseases.
??J.Kalaciriski,
A.Wojdylo, K.Kurczych, B.Kalacidska, R.BeretaKurczych. PARENTERAL AND ENTERAL NUTRITION IN PATIENTS EXTENSIVE AFTER SURGICAL PROCEDURES IN POSTOPERATIVE PERIOD. Dept.of General Surgery,Dept.of Anaesthesia and Int.Care, Dept.of Pharmacy, City Hospital, 08wiccim,Poland.
Nutritional treatment patient undergoing extensive surgical procedur& is -a condition of shortening catabolic phase of postoperative period. Giving’ a basal quantity of nutritional components, authors tried to do a clinical evaluation treated patients and possibilities of the nutritional treatment in a provincial hospital. 25 patients were divided into 3 groups: l-treated with laparostomy because of pancreatic necrosis, 2-after total gastrectomy, 3-after extensive resections of jejunum or colon with complications. Clinical status, weight loss, accessible laboratory investigations was studied. Authors gave on the average: energy 31.9 kcal/‘kg/day, protein 0.15 gN/kg/day, potassium 1.35 mq /kg/day. In 19 patients appeared weight loss 3.36 kg. In 20 patients with decreased serum protein level or blood cell count- plasma and erythrocytes were applied. In examined groups 3 persons died because of myocardial infarction, pulmonary embolism and intestinal necrosis with peritonitis. Conclusions: 1. Effective treatment of postoperative complications and low mortality must be attribute to nutritional treatment. 2. Adequate nutritional components administration should be applied intravenously, enterally or by both of them. 3. The best effects of nutrition are obtained by nutritional team cooperating with department of surgery, intensive care unit and a patient’s family. 4. Economical conditions of provincial hospitals cause important difficulties in applying of nutritional support in perioperative period.