| BackgroundAccelerated postoperative rehabilitation is a series of perioperative optimization measures based on evidence based medicine,in order to achieve the goal of rapid rehabilitation.ERAS can reduce the postoperative complications,shorten the length of hospital stay,and reduce the cost of medical care by reducing the postoperative stress response,reasonable management of pain,early recovery of diet and early activities.ERAS has been developed in the Department of orthopedics,breast surgery,cardiothoracic surgery,gastrointestinal surgery,gynecology and obstetrics since 1997,when Kehlet was put forward by ERAS,a Danish surgeon.At present,the international community has issued a ERAS guide or expert consensus for elective colorectal surgery,rectal and orpelvic surgery,pancreaticoduodenectomy and gastrectomy.Hepatobiliary surgery is often complicated,trauma,postoperative complication rate is high,the concept of ERAS in the clinical application of the department of hepatobiliary surgery is very urgent and important.In recent years,a number of medical centers in hepatobiliary surgery patients in the implementation of ERAS,and achieved good results.Enteral or parenteral nutritional support is an important component of ERAS,which is closely related to the rehabilitation of patients.It refers to the treatment or alleviation of disease and enhance the clinical curative effect,according to the dietary measures taken by the principle of nutrition,nasal feeding,intravenous route of amino acid,fat milk,glutamine and other nutrients into the patient,is to improve and maintain organ,organization,function and metabolism of cells and prevent multiple organ function failure of the important measures.Research shows that nutritional support therapy can improve the prognosis of patients with nutritional risk patients,nutritional support will not adversely affect the rehabilitation of the patients;and for patients without nutritional risk and nutritional support may not improve outcomes,even aggravate the liver metabolic burden caused by the abuse of nutritional support.With the rise of nutritional support,there are millions of cases of parenteral nutrition support in the future.It is necessary to determine the indication of nutritional support objectively.It is necessary to determine whether the patient has nutritional risk".Patients with nutritional risk should be developed and implemented in accordance with the specific circumstances of the clinical nutrition support program.Patients without nutritional risk should not be blindly nutritional support,so as not to increase the economic burden of patients,waste of limited resources.To this end,the Chinese Medical Association parenteral nutrition branch of the establishment of the "nutrition" multi center Collaborative Group conducted a nationwide joint investigation,in order to provide the basis for the formulation of relevant national policies.This subject is a single center branch structure of this work."Nutritional risk screening(NRS2002)" is a nutritional risk screening toolapplied to the inpatients made by Professor Kondrup etc.based on 128 RCTstudies in 2002,and it is the only one built on the basis of evidence-based medicine.The purpose of buildingthis tool is to select those patients who can be improved the clinical outcome through nutrition support."NRS2002" have a very good application adaptability at home and abroad because it is relatively simple to use."NRS2002" have achieved good results in nutritional risk screening of gastrointestinal,respiratory system cancer patients,but it is relatively few reports for hepatobiliary diseases during peri-operative nutrition risk screening and nutritional support guiding.In the clinical situation,nutritional risk or malnourished is not uncommon in Hepatobiliary disease patients.The liver is the center of energy metabolism.Hepatobiliary surgical diseases occur will affect the liver metabolism,and it has a way different from the general gastrointestinal disorders in nutritional support time,dosage,or form,etc.Unreasonable nutritional intake can not only improve patient outcomes,but would adversely affect the patient.Therefore,hepatobiliary disease patients treated with nutritional support in particular should strictly control indications.It is necessary to take the nutritional support treatment for the patients most in needand take reasonable decisions about their different nutritional support programs."Nutritional risk screening" is the 2002 professor Kondrup developed based on 128 RCT study for nutritional risk screening tools in hospitalized patients,is currently the only one built on the basis of evidence-based medicine on nutritional risk screening tools,the establishment of the tool to improve clinical outcomes can be screened by nutritional support of patients."NRS2002" because of its relatively simple and easy to use principle,in the domestic and international application has very good adaptability."NRS2002" on the nutritional risk screening in patients with respiratory system,gastrointestinal tumors have achieved good results,but for hepatobiliary diseases perioperative nutritional risk screening and application of nutritional support reported relatively less.Patients with liver and gallbladder diseases are not at risk of nutritional risk or malnutrition.The liver is the center of the energy metabolism,Department of hepatobiliary surgery disease occurs when the liver metabolism function produce certain effect,so the nutritional support duration,dosage form,type has unique characteristics different from general gastrointestinal diseases.Unreasonable nutrition intake can not only improve the prognosis of patients,but will adversely affect patients.Therefore,the application of nutritional support in liver disease patients should strictly grasp the indications,it is necessary to select the most suitable nutritional support treatment,nutritional support of patients,reasonable choice and the different nutritional support program.Gln(Glutamine)is one of the most studied amino acids in all kinds of amino acids.Gln is the most abundant amino acid in the body,but also all the rapidly proliferating cells such as epithelial cells and lymphocytes for growth and repair special energy material.Many studies have shown that Gln can help restore liver function and promote the prognosis of patients.Liver tissue contains glutamine synthetase and glutamine,which can not only synthesize but also break down Gln,and play an important role in the metabolism of Gln.But scholars also raised doubts,the Department of hepatobiliary surgery patients after surgery of the liver function damage,the use of Gln will not increase the burden of liver metabolism,but not conducive to the prognosis of patients,rapid recovery after surgery(ERAS)in violation of the idea?Guidelines for the use of Gln at home and abroad have different opinions.The clinical application of glutamine dipeptide belongs to the expensive medicine in the nutritional preparation.It is more important to consider its application value from the perspective of pharmacoeconomics.In view of the above situation,this paper will search in PubMed,Cochrane Library,Embase on the computer,China CNKI,Wanfang database on the relevant research literature on glutamine in Department of hepatobiliary surgery patients,the evaluation system for the effect of perioperative glutamine in Department of hepatobiliary surgery patients with liver function and immune function.At the same time,the effect of glutamine nutrition support on liver function in perioperative period of hepatobiliary surgery in Wuhan general hospital was investigated.Comparative analysis of glutamine nutritional support can improve the liver function of patients with liver and gallbladder surgery during perioperative period and promote their recovery.Through this work,we hope to provide some basis for the rational selection of glutamine in perioperative patients with Department of hepatobiliary surgery. |
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