Преабилитация хирургических больных: акцент на нутритивную поддержку
https://doi.org/10.33667/2078-5631-2025-35-46-53
Аннотация
Преабилитация – один из компонентов периоперационной медицины и важный этап лечения больных хирургического профиля, направленный на повышение функциональных возможностей пациента и адаптации его к хирургическому стрессу. Основными составляющими мультимодальной преабилитации являются: физические упражнения, адекватная нутритивная поддержка, психологическая помощь. Авторы обсуждают возможности оптимизации нутритивной поддержки с использованием продуктов энтерального питания у хирургических больных с целью повышения их реабилитационного потенциала, уменьшения выраженности саркопении и снижения числа осложнений в периоперационном периоде.
Об авторах
И. Н. Пасечник
ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской Федерации; ГБУЗ «Городская клиническая больница № 29 им. Н.Э. Баумана Департамента здравоохранения Москвы»
Россия
Россия
Пасечник Игорь Николаевич, заведующий кафедрой анестезиологии и реаниматологии, врач анестезиолог-реаниматолог отделения анестезиологии
Т. В. Новикова
ООО «Нутриция», Научно-медицинский департамент
Россия
Россия
Новикова Татьяна Валериановна, медицинский менеджер
А. А. Щучко
ГБУЗ «Городская клиническая больница № 29 им. Н.Э. Баумана Департамента здравоохранения Москвы»
Россия
Россия
Щучко Анатолий Анатольевич, заместитель главного врача по анестезиологии и реаниматологии
Список литературы
1. Watson S-L., Fowler A. J., Dias P. et al. The lifetime risk of surgery in England: a nationwide observational cohort study. Br. J. Anaesth. 2024; 133 (4): 768–775. DOI: 10.1016/j.bja.2024.06.028
2. Pasechnik I.N., Kurochkin M.S., Krylov S.V., Rybintsev V.Y. Perioperative medicine: is there a place for simulation technologies? // Virtual technologies in Medicine. 2024$1 (2). DOI: 10.46594/2687-0037_2024_2_1819
3. Achkasov S.I., Gubaidullin R.R., Ermakov N.A. Accelerated recovery program for surgical patients: Fast track. Collective monograph. Moscow: Limited Liability Company Publishing Group «GEOTAR-Media», 2017. 208 p. (Library of a Specialist Doctor). (In Russ.).
4. Zatevakhin I. I., Pasechnik I.N. The program of accelerated recovery in surgery (FAST TRACK) has been introduced. What’s the next? Grekov’s Bulletin of Surgery. 2018; 177 (3): 70–75. (In Russ.). https://doi.org/10.24884/0042-4625-2018-177-3-70-75
5. Abdulkerimov Z. A., Ardashev V. N., Barinov V. E. Surgical Patient. Moscow: Limited Liability Company Publishing Group «GEOTAR-Media», 2020. 336 p. DOI 10.33029/9704-5752-8-HBM‑2020-1-336
6. Wall J., Dhesi J., Snowden C., Swart M. Perioperative medicine. Future Healthc J. 2022; 9 (2): 138–143. DOI: 10.7861/fhj.2022-0051.
7. Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care. 2005; 8 (1): 23–32. DOI: 10.1097/00075197-200501000-00005
8. Bates A., West M. A., Jack S., Grocott M. P.W. Preparing for and Not Waiting for Surgery. Curr Oncol. 2024; 31 (2): 629–648. DOI: 10.3390/curroncol31020046
9. van Kooten R. T., Bahadoer R.R., Peeters K.C.M.J. et al. Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: A systematic review. Eur J Surg Oncol. 2021; 47 (12): 3049–3058. DOI: 10.1016/j.ejso.2021.07.021
10. Fleurent-Grégoire C., Burgess N., McIsaac D.I. et al. Towards a common definition of surgical prehabilitation: a scoping review of randomised trials. Br J Anaesth. 2024; 133 (2): 305–315. DOI: 10.1016/j.bja.2024.02.035
11. Rydbeck D., Bock D., Haglind E. et al. Survival in relation to time to start of curative treatment of colon cancer: A national register-based observational noninferiority study. Colorectal Dis. 2023; 25 (8): 1613–1621. DOI: 10.1111/codi.16638
12. Skořepa P., Ford K. L., Alsuwaylihi A. et al. The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr. 2024; 43 (3): 629–648. DOI: 10.1016/j.clnu.2024.01.020
13. Ricci C., Alberici L., Serbassi F. et al. Physical Prehabilitation in Patients who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach. Ann Surg Oncol. 2024; 31 (3): 1725–1738. DOI: 10.1245/s10434-023-14632-8
14. McIsaac D.I, Kidd G., Gillis C. et al. Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials. BMJ. 2025; 388: e081164. DOI: 10.1136/bmj‑2024-081164
15. Zhao X-N., Lu J., He H-Y., Ge S-J. Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study. World J Gastrointest Surg. 2024; 16 (7): 2211–2220. DOI: 10.4240/wjgs.v16.i7.2211
16. Zhong J., Kang K., Shu X. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr. 2015; 24 (3): 367–78. DOI: 10.6133/apjcn.2015.24.3.20
17. Gillis C., Fenton T.R., Gramlich L. et al. Malnutrition modifies the response to multimodal prehabilitation: a pooled analysis of prehabilitation trials. Appl Physiol Nutr Metab. 2022; 47 (2): 141–150. DOI: 10.1139/apnm‑2021-0299
18. Kondrup J., Allison S.P., Elia M. et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003; 22 (4): 415–21. DOI: 10.1016/s0261-5614(03)00098-0
19. Cederholm T, Jensen GL, Correia MITD et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019; 38 (1): 1–9. DOI:10.1016/j.clnu.2018.08.002
20. Risco R., González-Colom R., Montané-Muntané M. et al. Actionable Factors Fostering Health Value Generation and Scalability of Prehabilitation: A Prospective Cohort Study. Ann Surg. 2023; 278 (2): e217–e225. DOI: 10.1097/SLA.0000000000005662
21. Schindler K., Pichard C., Sulz I. et al. Nutrition Day: 10 years of growth. Clin Nutr. 2017; 36 (5): 1207–1214. DOI: 10.1016/j.clnu.2016.11.004
22. Elia M., Normand C., Norman K., Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016; 35 (2): 370–380. DOI: 10.1016/j.clnu.2015.05.010
23. Wischmeyer P., Carli F., Evans D., Guilbert S. et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia. Analgesia. 2018; 126 (6): 1883–1895. DOI: 10.1213/ANE.0000000000002743
24. Gillis C., Weimann A. Prehabilitation in surgery – an update with a focus on nutrition. Curr Opin Clin Nutr Metab Care. 2025. DOI: 10.1097/MCO.0000000000001112
25. Corriveau J., Alavifard D., Gillis C. Demystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology. Semin Oncol Nurs. 2022; 38 (5): 151336. DOI: 10.1016/j.soncn.2022.151336
26. Ljungqvist O., Weimann A., Sandini M. et al. Contemporary Perioperative Nutritional Care. Annu Rev Nutr. 2024; 44 (1): 231–255. DOI: 10.1146/annurev-nutr‑062222-021228
27. Lobo D.N., Gianotti L., Adiamah A. et al. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020; 39 (11): 3211–3227. DOI: 10.1016/j.clnu.2020.03.038
28. Allison S.P. The uses and limitations of nutritional support The Arvid Wretlind Lecture given at the 14th ESPEN Congress in Vienna, 1992. Clin Nutr. 1992; 11 (6): 319–30. DOI: 10.1016/0261-5614(92)90082-2
29. Argilés J.M., Nefertiti Campos N., Lopez-Pedrosa J.M. et al. Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. J Am Med Dir Assoc. 2016; 17 (9): 789–96. DOI: 10.1016/j.jamda.2016.04.019
30. Damanti S., Senini E., De Lorenzo R. et al. Acute Sarcopenia: Mechanisms and Management. Nutrients. 2024; 16 (20): 3428. DOI: 10.3390/nu16203428
31. Hajibandeh S., Hajibandeh S., Jarvis R. et al. Meta-analysis of the effect of sarcopenia in predicting postoperative mortality in emergency and elective abdominal surgery. Surgeon. 2019; 17 (6): 370–380. DOI: 10.1016/j.surge.2018.09.003
32. Jones K., Gordon-Weeks A., Coleman C., Silva M. Radiologically Determined Sarcopenia Predicts Morbidity and Mortality Following Abdominal Surgery: A Systematic Review and Meta-Analysis. World J Surg. 2017; 41 (9): 2266–2279. DOI: 10.1007/s00268-017-3999-2
33. Montiel-Rojas D., Nilsson A., Santoro A. et al. Fighting Sarcopenia in Ageing European Adults: The Importance of the Amount and Source of Dietary Proteins. Nutrients. 2020; 12 (12): 3601. DOI: 10.3390/nu12123601
34. Gillis C., Fenton T. R., Sajobi T. T. et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr. 2019; 38 (3): 1053–1060. DOI: 10.1016/j.clnu.2018.06.982
35. Gillis C., Buhler K., Bresee L. et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 2018; 155 (2): 391–410. e4. DOI: 10.1053/j.gastro.2018.05.012
36. Yamamoto K., Nagatsuma Y., Fukuda Y.Y. et al. Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer. 2017; 20 (5): 913–918. DOI: 10.1007/s10120-016-0683-4
37. Friedman J., Lussiez A., Sullivan J. et al. Implications of sarcopenia in major surgery. Nutr Clin Pract. 2015; 30 (2): 175–9. DOI: 10.1177/0884533615569888
38. Sykes K.J., Gibbs H., Farrokhian N. et al. Pilot randomized, controlled, preoperative intervention for nutrition trial in head and neck cancer. Head Neck. 2023; 45 (1): 156–166. DOI: 10.1002/hed.27220
39. Fukuda Y, Yamamoto K, Hirao M. et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015; 22 (suppl 3): S778–S785.
40. Hurt R.T, McClave S.A., Martindale R.G. et al. Summary Points and Consensus Recommendations from the International Protein Summit. Nutr Clin Pract. 2017; 32 (1_suppl): 142S‑151S. DOI: 10.1177/0884533617693610
41. Willett W., Rockström J., Loken B. et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019; 393 (10170): 447–492. DOI: 10.1016/S0140-6736(18)31788-4
42. Moore DR, Robinson MJ, Fry JL. et al. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009; 89 (1): 161–8. DOI: 10.3945/ajcn.2008.26401
43. Food, Dietary Protein Quality Evaluation in Human Nutrition: Report of an FAO Expert Consultation, 2011, Auckland, New Zealand: Food and Agriculture Organization of the United Nations; 2013.
44. Yang H, Guerin-Deremaux L., Zhou L. et al. Evaluation of nutritional quality of a novel pea protein. Agro Food Industry Hi-Tech. 2012; 23 (6): 8–10.
45. Hertzler SR, Lieblein-Boff JC, Weiler M, Allgeier C. Plant proteins: Assessing their nutritional quality and effects on health and physical function. Nutrients. 2020; 12 (12): 3704. DOI: 10.3390/nu12123704
46. Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G. Effect of a vegetable-protein-rich polymeric diet treatment on body composition and energy metabolism in inactive Crohn’s disease. Eur J Gastroenterol Hepatol. 2000; 12 (1): 5–11. DOI: 10.1097/00042737-200012010-00003
47. Messina M, Lynch H, Dickinson JM, Reed KE. No Difference Between the Effects of Supplementing with Soy Protein Versus Animal Protein on Gains in Muscle Mass and Strength in Response to Resistance Exercise. Int J Sport Nutr Exerc Metab. 2018; 28 (6): 674–685. DOI: 10.1123/ijsnem.2018-0071
48. Li C, Meng H, Wu S. et al. Daily Supplementation with Whey, Soy, or Whey-Soy Blended Protein for 6 Months Maintained Lean Muscle Mass and Physical Performance in Older Adults With Low Lean Mass. J Acad Nutr Diet. 2021; 121 (6): 1035–1048.e6. DOI: 10.1016/j.jand.2021.01.006
49. Banaszek A, Townsend JR, Bender D. et al. The Effects of Whey vs. Pea Protein on Physical Adaptations Following 8-Weeks of High-Intensity Functional Training (HIFT): A Pilot Study. Sports (Basel). 2019 Jan 4; 7 (1): 12. DOI: 10.3390/sports7010012.
50. Liu J., Klebach M., Visser M., Hofman Z. Amino Acid Availability of a Dairy and Vegetable Protein Blend Compared to Single Casein, Whey, Soy, and Pea Proteins: A Double-Blind, Cross-Over Trial. Nutrients. 2019; 11 (11): 2613. DOI: 10.3390/nu11112613
51. Berger M.M., Shenkin A., Schweinlin A. et al. ESPEN micronutrient guideline. Clin Nutr. 2022; 41 (6): 1357–1424. DOI: 10.1016/j.clnu.2022.02.015
52. Reintam Blaser et al, Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology, Nutr Clin Pract. 2021;36(1):40–49. doi: 10.1002/ncp.10599.
53. Kuyumcu et al. A Noncoagulating Enteral Formula Can Empty Faster From the Stomach: A Double Blind, Randomized Crossover Trial Using Magnetic Resonance Imaging, Journal of Parenteral and Enteral. 2014. DOI: 10.1177/0148607114528981
54. Goelen et al. Effect of protein composition of enteral formula on gastric content volume during continuous feeding: A randomized controlled crossover study in healthy adults, Clinical Nutrition. 2021; 40: 2663–2672. https://doi.org/10.1016/j.clnu.2021.03.021
55. van Eck EB, Hofman Z, van Eijnatten EJM, Knol J, Renes IB, Abrahamse E. Plant protein dominant enteral nutrition, containing soy and pea, is non-coagulating after gastric digestion in contrast to casein dominant enteral nutrition. Food Res Int. 2024 Dec; 197 (Pt 1): 115162. DOI: 10.1016/j.foodres.2024.115162. Epub 2024 Oct 2. PMID: 39593374
Рецензия
Для цитирования:
Пасечник И.Н., Новикова Т.В., Щучко А.А. Преабилитация хирургических больных: акцент на нутритивную поддержку. Медицинский алфавит. 2025;(35):46-53. https://doi.org/10.33667/2078-5631-2025-35-46-53
For citation:
Pasechnik I.N., Novikova T.V., Shchuchko A.A. Prehabilitation of surgical patients: focus on nutritional support. Medical alphabet. 2025;(35):46-53. (In Russ.) https://doi.org/10.33667/2078-5631-2025-35-46-53
Просмотров:
109
JATS XML
Послать статью по эл. почте 