RESUMEN

A nutritional evaluation was carried out in 43 cirrhotic outpatients who came to the Digestive Disease Department of the Edgardo Rebagliati Martins Hospital for a checkup. The evaluation included a dietary composition analysis; nutritional status through the analysis of lean and fatty mass through anthropometric parameters (tricipital skin fold thickness, midarm muscle circumference, muscle arm circumference and creatinine excretion in the 24 h urine/height ratio), measuring of visceral proteins (albumin, transferrin) and bioelectric Impedance. Finally, a nutritional dietary intervention was made according to international standards for cirrhotic patients. The Child - Pugh score was: Child A: 16 patients (37.1%), Child B: 20 patients (46.5%) and Child C: 7 patients (16.4%). The dietary analysis showed the following: Hypoprotein diets in 42 patients (98%), hypocaloric diets in 38 patients (88%), low fat diets in 36 patients (83.7%) only one patient had a normal diet. Nutritional status was normal in 15 patients (35%), 24 patients had protein malnutrition (56%) and 4 patients had protein-calorie malnutrition (9.3%). There was an association between Child B and C and the malnutrition diagnosis was (p = 0.045). The nutritional intervention was carried out in 19 of the 43 patients (dietary therapy) during 15 months; the results were 17 hospital admissions in the group without nutritional intervention and 6 in the group that had received nutritional intervention: (p = 0.01). Malnutrition and inadequate diets are becoming a prevalent problem in our cirrhotic population. Nutritional support may provide an additional and valuable therapy to decrease patient morbidity.

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RESUMEN

En el contexto de la realidad tecnológica latinoamericana se presentan el problema del soporte nutricional artificial en el Perú comparando la amplísima difusión del uso de antibiótico versus la marcada ausencia del uso de nutrición artificial, siendo ello un factor en contra del paciente seriamente comprometido dada la positiva gravitación del uso de soporte nutricional enteral sobre la inmunidad de un paciente. La presentación de un estudio prospectivo del uso de 3 diferentes fórmulas de nutrición enteral en 4 pacientes tipo, permiten mostrar las consecuencias adecuadas del uso de la nutrición enteral y las razones por las cuales el soporte nutricional artificial debe ser de aplicación sujeta a regulaciones legales en el Perú.

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RESUMEN

Se reporta un protocolo de estudio prospectivo de 10 años sobre 28 pacientes operados, por fístulas enterocutáneas postoperatorias en una unidad referencial quirúrgica de soporte nutricional artificial (SNA), de un total de 284 pacientes con dicho tipo de fístulas. Sobrevivieron 24/28 (85.7 por ciento) pacientes. Requirieron SNA, 26/28 (92.9 por ciento) pacientes en sus variedades enteral y/o parenteral. Se destacan tres aspectos: 1ro, la importancia vital de un equipo interdisciplinario de soporte nutricional artificial para obtener replección nutricional adecuada con mínima morbimortalidad derivadas de un soporte nutricional farmacológico , 2do., la falla orgánica múltiple como causa principal de mortalidad si el tratamiento quirúrgico no es exitoso, y 3ero, el manejo protocolizado de estos pacientes para la toma de decisiones quirúrgicas. El SNA adecuado es de vital importancia para evitar o dismimuir la morbimortalidad derivada de las fístulas que complican un acto quirúrgico así como es la piedra angular en donde descansa la posibilidad de solucionar quirúrgicamente esta complicación.

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RESUMEN

A prospective 10-year protocol is reported. Twenty-eight patients were operated from postoperatory intercutaneous fistulas by the same surgeon. They were treated at a Surgical Referral Unit of Artificial Nutritional Support (SNA), acronym in Spanish from 284 patients with similar fistulas. Survival was of 85.7 per cent (24/28). A 92.9 per cent of patients (26/28) required SNA either enteral and/or parenteral. Three major aspects should be considered: First, the vital importance on an Artificial Nutritional Support team in order to attain nutritional repletion with the lowest possible morbimortality derived from a Phamacological Nutritional Support. Second, should surgical treatment be unsuccessful, multiple organ failure is the main cause of mortality. Third, surgical decision making shoul be based on established protocols.An adequate SNA is of major importance to avoid or decrease morbimortality derived from postoperatory fistulas, and at the same time, it is the cornerstone to resolve this complication surgically.