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1、CHAPTER6METABOLISMINSURGICALPATIENTSAhmedAl-Mousawi,NoeA.Rodriguez,andDavidN.Herndon5nutrition(PN)inthelate1960s,Dudrickrecognizedthatnutritionalrequirementsmalnourishedsurgicalpatientswithapreexistingproteindeficitnutritionalassessmentandmonitoringwereatincreasedriskofcomplications.n
2、utritionalsupportItwasthenshownthatthehypermetabolicresponseseenprinciplesguidingroutesofnutritioninpatientswithmajorburnsresultedinpartfromanincreasespecialconsiderationsincatecholamineserumlevelsandthatthemetabolicresponsesummarycouldbeattenuatedbyambienttemperatureandpharmacologicm
3、eans.Furtherstudiesshowedthatseveretraumaandburnsleadtoahypercatabolicresponse,withdeleteriouseffectsonvariousorgans,andthattheinflammatoryresponsecontributesMetabolisminvolvesadiverserangeofchemicalprocessestohypermetabolismandsubsequentcatabolismseenfollowing6requiredtosustainlifean
4、denablegrowth,healing,develop-severeinjury(Fig.6-1).Modulationofthishypermetabolicment,reproduction,homeostasis,andadaptationandresponseresponsethroughpharmacologicandnutritionalinterventions,totheenvironment.Throughhighlyefficientmetabolicpath-alterationoftheenvironment,andimprovedsu
5、rgicalmanage-ways,nutrientsareabsorbed,transformed,andbrokendowntomentarecornerstonesofadvancingsurgicalcare.releaseenergy.ThenutritionalstatusofanindividualdependsAlthoughwidelyquoted,theclassicdescriptionoftheebbonanadequatediet,functionofthealimentarytract,andphysi-andflowresponsem
6、aynotbeaptforcriticallyillpatientsinaologiccondition.Insurgicalandcriticallyillpatients,metabolicmodernintensivecaresetting.Arefineddescriptionhasbeenandnutritionalprocessesmaybeimpairedasaconsequenceofproposedforthesepatients,whomaysufferfurtherinsultsfromenvironmental,pathologic,ort
7、raumaticfactors,leadingtoamultipleoperationsorrepeatedboutsofsepsis(Fig.6-2).Theneedfornutritionalsupplementationtoenablehealingandclassicdescriptionmayalsooversimplifythearrayofresponsesrecovery.Developmentandimplementationofnutritionalthatoccur;theseremainincompletelyunderstood,part
8、icula
