Características da ressecção intestinal de pacientes internados em um hospital público universitário, em um período de cinco anos, e que evoluíram para óbito: conduta nutricional adotada

Abstract

INTRODUCTION: Nutrients present site-specific digestion and absorption. After bowel resection, the clinical manifestations, including protein-energy malnutrition, are influenced by the resected segment, extent of resection and the functional capacity of the remaining segments. The prescribed nutritional therapy should be individualized and specialized, considering characteristics of the remaining intestinal segments, nutritional status and clinical time. The study aims were to analyze in medical records the description of the characteristics of resection of intestinal segments and nutritional management implemented for patients undergoing to bowel resection. MATERIALS AND METHODS: A non-concurrent cohort study using semi-structured and specific form. Medical records of 55 patients undergoing to bowel resection in 2007/August at 2012/July period, and evolved to death, were analyzed. RESULTS: Among the records analyzed, most were male (n=30 patients, 54.6%), mean age 60.2±17.8 years, who underwent only one bowel resection (n=45, 81.8 and the main causal factor was vascular ischemia mesenteric (n=17). The description of the resected bowel segment was not performed for 31 patients (56.4%). The description length of small intestine resected was performed in ten patients exclusively by the team of pathology. Description of the remaining length of the small intestine (n = 10) were classified as short bowel syndrome (n = 9) or intestinal failure (n = 4) syndrome. The assessment of nutritional status was performed for 33 patients (60%), 1.7 ± 0.7 different methods associated form being used. The assessment of nutritional status identified malnutrition (n = 15, 68.2% of reviews) and was significantly. For the nine patients diagnosed with Short Bowel Syndrome, three (75%) received as the first dietary prescription parenteral nutrition and enteral nutrition received polymer (25%). Exclusive oral diet was given to malnourished patients undergoing to bowel resection. Twenty-eight patients (50.1% of the sample) received ministry diet after conducting enterectomies, 23 patients (41.8%) fasted on average by 3.2 days in the postoperative period and four patients (7.3 %) died in the immediate postoperative period. Sepsis and septic shock were the main cause of death (n = 30). The average period since the last or only bowel resection until death was 76.5 ± 194.4 days. CONCLUSION: The no description of resected and remaining intestinal segments was frequent and may have contributed to the development / worsening of malnutrition among the patients undergoing to bowel resection, which evolved to death.