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위암의 근치적 위절제술 후 생체 전기 임피던스법을 이용한 체성분 변화의 1년간 추적관찰
황시은,김찬영,양두현,Hwang, Si-Eun,Kim, Chan-Young,Yang, Doo-Hyun 대한위암학회 2007 대한위암학회지 Vol.7 No.4
목적: 위암의 위절제술 후, 생체전기 임피던스법을 이용하여 1년 동안 체성분 변화를 알아봄으로써 위절제술에 따른 영양, 생리학적 연구의 기초 자료로 활용하고자 하였다. 대상 및 방법: 2003년 11월부터 2004년 11월까지 위암으로 근치적 위절제술을 시행 받고, 본 연구에 사전 동의를 해준 98명을 대상으로 생체 전기 임피던스법(Inbody 4.0, Biospace, Korea)을 이용하여 간단한 임상적 지표에 따른 변화를 알아보았다. 결과: 체중은 술 후 1개월까지 6.7%, 6개월까지 9.4%의 감소를 보인다(P<0.01). 제지방량은 4개월까지 4.9%의 감소를 보이고 이후에는 변화하지 않았다(P<0.01). 체지방량과 내장지방은 6개월 동안 24.3%, 14.1%의 감소를 보였다(P<0.01). 여자가 남자에 비해 체중, 제지방량, 내장지방의 감소가 많았다(P<0.05). 병기 III-IV기 환자가 I-II기에 비해 부종지수가 높게 나타났다(P<0.05). Billroth I, III Esophagoje-junostomy에 따른 유의한 차이는 체지방량으로 12개월 때 감소비율이 각각 27.6%, 22.1%, 41.2%이었다(P<0.05). 결론: 위절제 후의 부족한 영양 섭취와 체중 감소의 개선은 삶의 질과 관계되므로 영양, 생리학적 연구의 관심이 필요하다. 체성분 분석에 있어서 생체전기 임피던스법은 유용하게 사용될 수가 있었고 본 결과가 향후 위 절제와 관련된 영양생리학적 연구에 응용되기를 희망한다. Purpose: We have evaluated changes of body composition for patients that underwent a radical gastrectomy for stomach cancer by the use of available bioelectrical impedance analysis during the first year following surgery. We plan to utilize these findings in nutritional and physiological studies. Materials and Methods: We evaluated clinical changes in body composition in patients using the bioelectrical impedance method (Inbody 4.0, Biospace, Korea), between November 2003 to November 2004. A total of 98 patients agreed to enroll in this study among all of the patients that underwent a radical gastrectomy. Results: The average weight decreased by 6.7%, and 9.4%, within the first and 6 months after surgery, respectively (P<0.01). The fat free mass (FFM) dropped by 4.9% within the first month and there were no more changes after this period (P<0.01). The fat mass (FM) and visceral fat area (VFA) decreased 24.3% and 14.1% within the first 6 months (P<0.01), respectively. The reduction effects for female patients were greater than for male patients for weight, FFM and VFA (P<0.05). The edema index was higher in patients with stage III-IV disease than in patients with stage I-II disease (P<0.05). There were significant differences for Billroth I and Billrothl II patients as compared to patients that underwent an esophagojejunostomy for a reduction of the FM, as measured in the in the 12th month after surgery (27.6%, 22.1%, and 41.2%, respectively; P<0.05). Conclusion: Since nutritional supplementation and an improvement in body weight loss after a radical gastrectomy is significantly related with quality of life, nutritional and physiological studies should be greatly considered. In this study, bioelectrical impedance analysis was very useful in analyzing the diminution of body composition and we hope this study on the nutritional and physiological aspects related to a radical gastrectomy will be useful for later studies.
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위장관 수술 후 발생한 장관 누공 환자에서 영양집중지원팀에 의뢰된 내용 분석
정미진 ( Mi Jin Jeong ),유희철 ( Hee Chul Yu ),황시은 ( Si Eun Hwang ),김찬영 ( Chan Young Kim ),이민로 ( Min Ro Lee ),김선형 ( Sun Haeng Kim ),김행순 ( Hyeong Seon Kim ),김주신 ( Ju Sin Kim ),문미경 ( Mi Kyung Moon ),윤완기 ( Wan 한국정맥경장영양학회 2010 한국정맥경장영양학회지 Vol.3 No.1
Purpose: The role of nutrition support for the management of enterocutaneous fistula is primarily one of supportive care to prevent malnutrition and thereby halt further deterioration of an already debilitated patient. This therapy is best managed by a nutritional support team (NST). For activation of the NST, physicians must become more aware of the need for nutrition support in patients, and so referrals are required from physicians. This study examined the referrals to the nutritional support team for patients with postoperative enterocutaneous fistula. Methods: Between March 2007 and May 2009, we reviewed 34 patients with postoperative enterocutaneous fistula and who was referred to the NST. Results: The mean age of the patients was 61.1±11.5years. Twenty seven cases were males and 7 were females. The routes of nutrition support were EN+PN: 32 (55.2%), PN: 16 (27.6%), EN: 8 (13.0%) and oral intake+PN: 2 (3.4%). The direct referrals were 45 (77.6%) and the indirect referrals though the nutritional screening system were 13 (22.4%). The referrals for EN were 40 (69%) and those for PN were 18 (31.0%). The recommendations by the NST were accepted in 48 (82.8%) of the cases. The EN recommendations were accepted in all 40 (100.0%) of the cases. The PN recommendations by direct referral were accepted in 6 of 7 cases, but only 2 of 11 cases were accepted according to indirect referral. Conclusion: More aggressive and thorough follow-up on whether or not to accept the NST recommendation is required. This study shows that regular scheduled nutrition support service orientations for the different staff and departments of the hospital should be held each year. (KJPEN 2010;3(1):45-49)
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