Conséquences de l'acte opératoire sur l'état nutritionnel [Consequences of surgery on nutritional status]

Details

Serval ID
serval:BIB_FD80EA164A3B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Conséquences de l'acte opératoire sur l'état nutritionnel [Consequences of surgery on nutritional status]
Journal
Annales Françaises d'Anesthésie et de Réanimation
Author(s)
Chioléro R.
ISSN
0750-7658
Publication state
Published
Issued date
1995
Peer-reviewed
Oui
Volume
14 Suppl. 2
Pages
39-46
Language
french
Notes
Publication types: English Abstract ; Journal Article ; Meta-Analysis
Abstract
Trauma and surgery induce extensive physiological changes, commonly denominated the acute phase reaction (APR). This APR is activated by various kinds of stimuli, namely nociceptive stimulations, tissue injury, tissue ischaemia and reperfusion as well as by haemodynamic disturbances which occur commonly in such patients. APR is mainly characterised by the release of counter-regulatory hormones, complex metabolic changes and by the hepatic synthesis of numerous acute phase factors (C-reactive protein, haptoglobin, complement protein, etc). In addition, fever is typically present and there is a resistance to the nutritional support. The intensity of APR is variable, according to the extent of surgery, the subsequent course, occurrence of complications and to various factors related to the patient and its treatment. In patients with non complicated surgery and low or moderate severity trauma, the metabolic changes are minor and self-limited. In such a condition, there is no need for nutritional support. Conservely, in patients with complicated surgery or major trauma, there is an extensive APR, which can be very prolonged. This results in important and sustained metabolic changes, leading to extensive catabolism and progressive loss of body cell mass. The latter is amplified by the decreased body ability to adapt to starvation and by the resistance to the nutritional support that typically occur in complicated postoperative and trauma patients. Total parenteral nutrition does not prevent from metabolic changes occurring in surgical patients. By contrast, several experimental and human studies have shown that early enteral nutrition may alleviate both the endocrine and metabolic responses in such conditions. Regional anaesthesia, particularly by the epidural route, may also decrease but not abolish the extent of APR.
Keywords
Acute-Phase Proteins/metabolism, Acute-Phase Reaction/metabolism, Body Composition, Energy Metabolism, Female, Food Deprivation/physiology, Glucose/metabolism, Humans, Lipid Metabolism, Male, Nutritional Status, Proteins/metabolism, Stress, Psychological/complications, Surgical Procedures, Operative
Pubmed
Web of science
Create date
24/01/2008 16:52
Last modification date
20/08/2019 16:28
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