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Abstract(s)
O doente cirúrgico é um grupo heterogéneo e com uma grande diversidade de diagnósticos, no qual se encontram diferentes estadios de gravidade de doença. Para além disto, o doente é submetido em muitos casos a cirurgias de grande porte que inviabilizam a via oral, o que interfere na evolução clínica do doente, com relação direta nos outcomes cirúrgicos. Daqui advém a importância do Suporte Nutricional Terapêutico (SNT) efetivo, adequado e ajustado ao doente que é incapaz de satisfazer adequadamente as suas necessidades nutricionais diárias por via oral. No presente trabalho foi avaliado a relação entre o SNT efetivo e as complicações cirúrgicas em 59 doentes do CHLN-HSM com um tempo médio de internamento de 40,81±22 dias. Tratou-se de um estudo quantitativo, observacional, transversal e analítico. Pela aplicação do NRS-2002, verificou-se que a totalidade da amostra estava desnutrida e pelo SGA confirmou-se que 42,4% desta estava em desnutrição severa. Os diagnósticos principais foram: patologia gástrica, neoplasia intestinal e choque sético, sendo que pela escala Clavien-Dindo, 44,1% da amostra foi avaliada como grau IIIb, 35,6% grau II, 10,2% grau IVa e 5,1% grau IIIa. Em relação ao balanço energético, verificou-se que o VET administrado (830±488kcal) cumpriu 79% e 78% face ao VET calculado (1460±154kcal) e ao prescrito (1300±332kcal), mas só assumiu valores >90% a partir do dia 12 do estudo. Em relação aos macronutrientes, verificou-se que o aporte fornecido foi sempre inferior ao aporte prescrito e ao calculado. Verificaram-se ainda como principais fatores que contribuíram para o underfeeding proteico-calórico apontado, a ausência do doente para exame e/ou cirurgia com 49,1%, as complicações gastrointestinais com 42,1%, os problemas mecânicos com 38,6% e os procedimentos de transição para a dieta oral com 35,1%. Não foi encontrada correlação significativa entre o SNT fornecido e o tempo de internamento, o procedimento cirúrgico ou o grau de complicações cirúrgicas.
ABSTRACT - A surgical patient is a heterogeneous group with a great diversity of diagnoses, in which different stages of disease severity are found. Besides this, the patient is submitted in many cases to large surgeries that make the oral route unfeasible, which interferes with the clinical evolution of the patient, with a direct relationship in surgical outcomes. Hence, the importance of effective Nutritional Therapeutic Support (NTS), is adequate and adjusted to the patient who is unable to adequately meet their daily nutritional needs through the oral route. Translated with www.DeepL.com/Translator (free version)In the present study, the relationship between effective NTS and surgical complications was evaluated in 59 CHLN-HSM patients with a mean length of stay of 40.81±22 days. It was a quantitative, observational, cross-sectional, and analytical study. By the application of NRS-2002, it was verified that the totality of the sample was malnourished and by the EMS it was confirmed that 42.4% of it was severely malnourished. The main diagnoses were: gastric pathology, intestinal neoplasia, and septic shock, and by Clavien-Dindo scale, 44.1% of the sample was evaluated as grade IIIb, 35.6% as grade II, 10.2% as grade IVa and 5.1% grade IIIa. Regarding the energetic balance, it was verified that the VET administered (830±488kcal) complied with 79% and 78% compared to the calculated VET (1460±154kcal) and the prescribed VET (1300±332kcal), but only assumed values >90% from day 12 of the study. Regarding macronutrients, it was verified that the contribution provided was always lower than the prescribed and calculated contribution. The main factors contributing to the protein-calorie underfeeding were the absence of the patient for examination or surgery at 49.1%, gastrointestinal complications at 42.1%, mechanical problems at 38.6%, and transition procedures to oral diet at 35.1%. No significant correlation was found between the NTS provided and the length of stay, the surgical procedure, or the degree of surgical complications.
ABSTRACT - A surgical patient is a heterogeneous group with a great diversity of diagnoses, in which different stages of disease severity are found. Besides this, the patient is submitted in many cases to large surgeries that make the oral route unfeasible, which interferes with the clinical evolution of the patient, with a direct relationship in surgical outcomes. Hence, the importance of effective Nutritional Therapeutic Support (NTS), is adequate and adjusted to the patient who is unable to adequately meet their daily nutritional needs through the oral route. Translated with www.DeepL.com/Translator (free version)In the present study, the relationship between effective NTS and surgical complications was evaluated in 59 CHLN-HSM patients with a mean length of stay of 40.81±22 days. It was a quantitative, observational, cross-sectional, and analytical study. By the application of NRS-2002, it was verified that the totality of the sample was malnourished and by the EMS it was confirmed that 42.4% of it was severely malnourished. The main diagnoses were: gastric pathology, intestinal neoplasia, and septic shock, and by Clavien-Dindo scale, 44.1% of the sample was evaluated as grade IIIb, 35.6% as grade II, 10.2% as grade IVa and 5.1% grade IIIa. Regarding the energetic balance, it was verified that the VET administered (830±488kcal) complied with 79% and 78% compared to the calculated VET (1460±154kcal) and the prescribed VET (1300±332kcal), but only assumed values >90% from day 12 of the study. Regarding macronutrients, it was verified that the contribution provided was always lower than the prescribed and calculated contribution. The main factors contributing to the protein-calorie underfeeding were the absence of the patient for examination or surgery at 49.1%, gastrointestinal complications at 42.1%, mechanical problems at 38.6%, and transition procedures to oral diet at 35.1%. No significant correlation was found between the NTS provided and the length of stay, the surgical procedure, or the degree of surgical complications.
Description
Mestrado em Nutrição Clínica
Keywords
Nutrição Doente cirúrgico Suporte nutricional terapêutico Nutrição artificial Complicações cirúrgicas Nutrition Surgical patient Therapeutic nutritional support Artificial nutrition Surgical complications
Pedagogical Context
Citation
Santos RH. Terapia nutricional artificial efetiva e complicações no doente cirúrgico [dissertation]. Lisboa: Faculdade de Medicina da Universidade de Lisboa; Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2020.