透析患者の消化管手術における術前術後の栄養管理について

Pre and Post operative nutrition in renal failure patients is a key point in the success of their gastrointestinal surgery. In general, such nutrition is made intravenously or enterally. The latter technigue includes elemental diet, tube feeding and oral intake.<br>The control of fluid, calory and electrolytes must be paid special attention in dialysis patients. In the past 44 months, 12 gastrointestinal operations were performed in which 5 patients showed improvement in the diseases, although the remaining 7 patients died. When the causes of the deaths were evaluated, most of the diseases were malignant, and the admission to the hospital, as well as the operation was of the emergency, and pre-operatively, the patients were at poor risk. In addition, we consider that post-operatively, there was absolute lack of the volume of the food and high calory fluid intake. Furthermore, we have had little experience of such big surgery in dialysis patients and it seems we put too much limitation to dialysis frequency and fluid intake.<br>In the 5 succeeded patients, the factors such as that the large percentage of the total calory, post-operatively, was taken orally and that pre-operatively adequate calory (45cal/Kg) was ingested orally, must have led to the good results.<br>Post-operative peritoneal dialysis is becoming unnecessary in our hospital and an increase in supplement fluid can be inhibited by conducting ECUM (Extracorporeal Ultrafiltration Method). We believe that the technique of post-operative clinical care has been established to a considerable degree by our experience. Furthermore, the nutrition control will become perfect, if we can give adequate volume of low residue fluid diet to patients at the earliest moment after the recovery of the function of the gastrointestine was seen. We are encouraged to make further effort to increase the success rate of the surgery by inclusing in the reevaluation the starting period of feeding fluid diet, food taste of the patients and the volume of the foods eaten by them.