Nutrition blending recommendation method used after surgical operation

Abstract

The invention discloses a nutrition allocation recommendation method used after a surgical operation, and relates to the technical field of clinical medicine, and the method comprises the following specific steps: stage division, stage preparation formula design, supply adjustment and stage conversion recommendation and monitoring, and scheme optimization. Postoperative nutrition allocation is divided into three stages, namely an adaptive feeding stage, a transitional nutrition stage and a comprehensive nutrition support stage, and an enteral nutrition preparation with a specific ratio is designed for each stage, so that high synchronization of nutrition supply and postoperative physiological metabolism characteristics is ensured; in the first stage, a hypotonic formula mainly comprising oligopeptide and free amino acid is adopted, so that the intestinal mucosa function is effectively protected, and intestinal peristalsis is promoted; in the second stage, by increasing the proportion of intact protein and soluble dietary fibers, energy and protein supply is improved, and the high metabolism requirement of the body is met; in the third stage, comprehensive and sufficient nutrition support is provided, and tissue repair and physical recovery are accelerated.

Description

Technical Field

[0001] This invention relates to the field of clinical medical technology, specifically to a recommended method for postoperative nutritional management. Background Technology

[0002] Surgical procedures, as an important means of treating various diseases, can effectively remove lesions. However, the surgical process itself triggers a series of complex metabolic and physiological changes after surgery, including a hypercatabolic state, increased inflammatory response, insulin resistance, and gastrointestinal function suppression. These changes are collectively referred to as surgical stress metabolism. Surgical stress metabolism leads to a large loss of protein, muscle atrophy, and decreased immune function after surgery, which seriously affects the postoperative recovery process, increases the incidence of complications, and length of hospital stay. Therefore, nutritional support, as an important component of postoperative rehabilitation management, is directly related to the quality and speed of rehabilitation due to its rationality and effectiveness.

[0003] However, traditional postoperative nutritional support methods often suffer from problems such as inconsistent timing of nutritional support, fixed nutritional formulas, and a lack of individualization and precision. Specifically, traditional methods often begin enteral nutrition support only after the patient passes gas, neglecting the importance of early enteral nutrition for the recovery of intestinal function and leading to delayed recovery. Furthermore, commonly used enteral nutrition formulas have fixed nutrient ratios, making it impossible to dynamically adjust them according to the physiological metabolic characteristics at different postoperative stages, thus failing to meet the body's dynamic nutritional needs. In addition, fixed nutritional plans lack individualized design, making it difficult to provide precise nutritional support for different surgical types and nutritional statuses, thereby affecting recovery outcomes. Premature or inappropriate enteral nutrition may also increase the risk of complications such as abdominal distension and diarrhea, further prolonging hospital stays and increasing medical costs. Summary of the Invention

[0004] The purpose of this invention is to overcome the shortcomings of existing technologies and provide a recommended method for postoperative nutritional management. This invention divides the postoperative nutritional management process into three stages: an adaptive feeding period, a transitional nutrition period, and a comprehensive nutritional support period. For each stage, a specific ratio of enteral nutrition formulation is designed to ensure a high degree of synchronization between nutritional supply and postoperative physiological metabolic characteristics. The first stage uses a low-osmotic formula mainly composed of oligopeptides and free amino acids, effectively protecting intestinal mucosal function and promoting intestinal peristalsis. The second stage increases the proportion of whole protein and soluble dietary fiber, enhancing energy and protein supply to meet the body's high metabolic needs. The third stage provides comprehensive and sufficient nutritional support, accelerating tissue repair and physical recovery. This step-by-step nutritional support strategy improves nutrient absorption efficiency and optimizes the recommendation process.

[0005] To solve the above-mentioned technical problems, the present invention provides the following technical solution: a recommended method for postoperative nutritional management, the specific steps of which are as follows: Phase Division: The postoperative nutritional management process is divided into three steps: the first stage is the adaptive feeding period, the second stage is the transitional nutrition period, and the third stage is the comprehensive nutritional support period. Stage formulation design: Three enteral nutrition formulations are designed for the three stages respectively. The first formulation is used in the first stage, using oligopeptides and free amino acids as the main nitrogen source. The second formulation is used in the second stage, using whole protein as the main nitrogen source. The third formulation is used in the third stage, providing nitrogen source entirely from whole protein. The first formulation was administered intermittently via a nasogastric tube. Recommendations for supply adjustment and phase transition: Assess the patient's gastrointestinal tolerance. If the patient tolerates the target feeding amount of the first formulation for more than 24 hours and has good gastrointestinal tolerance, switch to the second formulation. If the patient has good gastrointestinal tolerance, eats less than 60% of the target amount on their own, and test results indicate the need for higher levels of nutritional support, switch to the third formulation. Monitoring and protocol optimization: Continuously monitor patients' gastrointestinal tolerance and nutritional pre-set indicators. If intolerance occurs, stop the current formulation or switch back to the previous formulation type. Dynamically recommend enteral nutrition formulations based on monitoring results.

[0006] Furthermore, the three stages are divided based on the degree of intestinal function recovery, the process of metabolic state transformation, and the intensity of inflammatory response; the first stage is the adaptive feeding period, with a time window set from 0 to 24 hours post-surgery; the second stage is the transitional nutrition period, with a time window set from 2 to 3 days post-surgery; and the third stage is the comprehensive nutritional support period, with a time window set from the 4th day post-surgery until discharge.

[0007] Furthermore, in the design of the enteral nutrition formulation, the first formulation uses oligopeptides and free amino acids to provide more than 80% of the nitrogen source, while adding glutamine, adjusting the fat energy ratio to ≤15% and the carbohydrate energy ratio to ≤70%; the second formulation uses whole protein to provide 50%-80% of the nitrogen source, while adding soluble dietary fiber at an amount of 2-4g / 100g, adjusting the fat energy ratio to 20%-30% and the carbohydrate energy ratio to 50%-60%; the third formulation uses whole protein as the nitrogen source entirely, while adding soluble dietary fiber, adjusting the fat energy ratio to 25%-35% and the carbohydrate energy ratio to 45%-55%.

[0008] Furthermore, in the design of the enteral nutrition formulation, the mass ratio of oligopeptides to free amino acids in the first formulation is 3-5:1; the whole protein in the second formulation is casein or hydrolyzed whey protein; the whole protein in the third formulation is a mixture of casein, hydrolyzed whey protein and soy protein isolate, and the mass percentages of casein, hydrolyzed whey protein and soy protein isolate in the whole protein are 30%-40%, 30%-40% and 20%-30% respectively.

[0009] Furthermore, in the enteral nutrition formulations, the main carbohydrate component of the first, second, and third formulations is maltodextrin. Specifically, in the second and third formulations, maltodextrin accounts for 70%-90% of the total carbohydrate mass, and in the first formulation, the main carbohydrate component is maltodextrin, along with rice flour and glucose, which together account for 80%-95% of the total carbohydrate mass. The fat source of the first formulation is medium-chain triglycerides; the fat source of the second and third formulations is a mixture of medium-chain triglycerides and vegetable oil, with medium-chain triglycerides accounting for 20%-40% of the total fat mass.

[0010] Furthermore, the initial dilution ratio of the first preparation to water is 1:1 to 3:1, and the initial feeding dose is 0.5 to 1.5 ml per kilogram of body weight per hour; the interval between intermittent feedings is 2 to 3 hours, and the duration of each feeding is 30 to 50 minutes.

[0011] Furthermore, in the aforementioned recommendations for supply adjustment and phase transition, when monitoring patients' gastrointestinal tolerance, quantitative assessment is performed using the enteral nutrition tolerance scoring standard. In the first phase, monitoring of symptoms such as abdominal distension, diarrhea, vomiting, and abdominal pain is conducted. In the second and third phases, in addition to monitoring these symptoms, monitoring of bowel sound frequency is added. The enteral nutrition tolerance scoring standard is as follows: 0 points are recorded for the absence of abdominal pain, vomiting, and diarrhea; 0 points are recorded for the absence of abdominal pain, vomiting, and loose stools ≥3 times / day with a stool volume of 250mL ≤ <5g. A score of 1 is recorded when the intra-abdominal pressure is 15-20 mmHg, the gastric residual volume is 250 mL ≤ gastric residual volume < 500 mL, and the stool volume is ≥ 3 times / day with 500 mL ≤ stool volume < 1500 mL; a score of 5 is recorded when the intra-abdominal pressure is > 20 mmHg, the gastric residual volume is ≥ 500 ml, and the stool volume is ≥ 3 times / day with ≥ 1500 mL; before switching from the first formulation to the second formulation, the following conditions must be met simultaneously: the patient's enteral nutrition tolerance score remains between 0 and 2 points for 24 consecutive hours; and there is no abdominal distension or abdominal pain for 24 consecutive hours. Symptoms include diarrhea and vomiting; bowel movements occur 1-3 times daily. The second formulation should be diluted at a ratio of 1:1-2:1 initially, with an initial feeding dose of 1.5-2 ml per kilogram of body weight per hour. Before switching from the second to the third formulation, the following conditions must be met simultaneously: good gastrointestinal tolerance, enteral nutrition tolerance score maintained at 0-2 points; spontaneous food intake less than 60% of the target amount; and laboratory indicators suggesting the need for higher levels of nutritional support, specifically quantified by plasma protein levels: albumin 30.0-39.9 g / L. Prealbumin 160-199 mg / L, transferrin 1.50-2.49 g / L: mild malnutrition; albumin 25.0-29.9 g / L, prealbumin 100-159 mg / L, transferrin 1.00-1.49 g / L: moderate malnutrition; albumin <25.0 g / L, prealbumin <100 mg / L, transferrin <1.00 g / L: severe malnutrition. The third preparation is not diluted, and the initial dose is 2-2.5 ml per kilogram of body weight per hour.

[0012] Furthermore, in the recommended supply adjustment and phase transition, the target feeding amount for each phase is set as follows: the target feeding amount for the first phase meets 60%-80% of the patient's basic energy needs, the target feeding amount for the second phase meets 80%-100% of the patient's basic energy needs, and the target feeding amount for the third phase meets 100%-120% of the patient's basic energy needs; the patient's basic energy needs are determined based on weight and type of surgery.

[0013] Furthermore, in the monitoring and optimization of the program, when monitoring the preset nutritional indicators, fasting blood glucose is maintained within the normal metabolic range of 4.4-7.8 mmol / L. When fasting blood glucose is higher than 7.8 mmol / L, the proportion of carbohydrates in the current stage of the preparation is reduced; when fasting blood glucose is lower than 4.4 mmol / L, the proportion of carbohydrates in the current stage of the preparation is increased. Venous blood is collected on postoperative days 1, 3, and 7 to detect albumin, prealbumin, and hemoglobin levels. When albumin remains below 35 g / L, the energy ratio of protein in the current stage of the preparation is increased; when albumin is below 180 mg / L, branched-chain amino acids are supplemented; when hemoglobin is below 100 g / L, the amount of iron added is increased, along with vitamin C.

[0014] Compared with existing technologies, this recommended method for postoperative nutritional management has the following advantages: I. This invention divides the postoperative nutritional management process into three stages: an adaptive feeding period, a transitional nutrition period, and a comprehensive nutritional support period. Specific enteral nutrition formulations with specific ratios are designed for each stage, ensuring a high degree of synchronization between nutritional supply and postoperative physiological metabolic characteristics. The first stage uses a low-osmotic formula primarily composed of oligopeptides and free amino acids, effectively protecting intestinal mucosal function and promoting intestinal peristalsis. The second stage increases the proportion of whole protein and soluble dietary fiber, enhancing energy and protein supply to meet the body's high metabolic demands. The third stage provides comprehensive and sufficient nutritional support, accelerating tissue repair and physical recovery. This step-by-step nutritional support strategy improves nutrient absorption efficiency and optimizes the recommended nutritional process.

[0015] Second, this invention effectively stimulates intestinal peristalsis and maintains the integrity of the intestinal mucosal barrier by administering a hypotonic and easily absorbed first preparation through a nasogastric tube in the early postoperative period. As the postoperative stage progresses, the nutritional preparations, which are gradually increased, not only provide progressively enhanced energy and protein support, but also further enhance the intestinal immune function and microecological balance by adding ingredients such as glutamine and soluble dietary fiber. This effectively reduces the postoperative systemic inflammatory response and improves nutritional tolerance and compliance.

[0016] Other advantages, objectives and features of the invention will be set forth in part in the description which follows, and in part will be apparent to those skilled in the art from the following examination or study, or may be learned from the practice of the invention. Attached Figure Description

[0017] To more clearly illustrate the technical solutions in the embodiments of the present invention or the prior art, the accompanying drawings used in the description of the embodiments or the prior art will be briefly introduced below. Obviously, the drawings described below are merely some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without any creative effort.

[0018] Figure 1 This is a flowchart of a recommended method for postoperative nutritional management. Detailed Implementation

[0019] To further illustrate the technical means and effects of the present invention in achieving its intended purpose, the following detailed description of the specific implementation methods, structures, features, and effects of the present invention, in conjunction with the accompanying drawings and preferred embodiments, is provided below.

[0020] Example 1: Phase Division: In the application scenario of nutritional management after orthopedic joint replacement surgery, based on the physiological metabolic characteristics of slow recovery of intestinal function, transition from high catabolic to synthetic metabolic state, and strong inflammatory response after orthopedic joint replacement surgery, postoperative nutritional management is divided into three step-by-step phases. The first phase is the adaptive feeding period, with a time window set at 0-24 hours after surgery; the second phase is the transitional nutrition period, with a time window set at 2-3 days after surgery; and the third phase is the comprehensive nutritional support period, with a time window set at the 4th day after surgery until discharge.

[0021] Stage-specific formulation design: Three enteral nutrition formulations were designed for each of the three stages. The first formulation, used in the first stage, uses oligopeptides and free amino acids as the main nitrogen source, with a mass ratio of oligopeptides to free amino acids of 3:1. The nitrogen source provided by oligopeptides and free amino acids accounts for more than 80% of the total nitrogen source. Glutamine is added, and the fat energy ratio is adjusted to 12%, with medium-chain triglycerides as the fat source. The carbohydrate energy ratio is adjusted to 68%, with maltodextrin as the main component, and rice flour and glucose also included, accounting for 80% of the total carbohydrate mass. The second formulation is used in the second phase: It uses whole protein as the primary nitrogen source, specifically casein, which provides 50% of the total nitrogen. It is also supplemented with soluble dietary fiber at a rate of 2g / 100g. The fat energy ratio is adjusted to 20%, with the fat source being a mixture of medium-chain triglycerides and vegetable oil, where medium-chain triglycerides account for 20% of the total fat mass. The carbohydrate energy ratio is adjusted to 50%, with maltodextrin as the main component, accounting for 70% of the total carbohydrate mass. The third formulation is used in the third stage: it uses whole protein as the nitrogen source, which is a mixture of casein, hydrolyzed whey protein and soy protein isolate, with the three components accounting for 30%, 30% and 20% of the total mass of the whole protein, respectively. It is also combined with soluble dietary fiber, and the fat energy ratio is adjusted to 25%, with the fat source being a mixture of medium-chain triglycerides and vegetable oil, of which medium-chain triglycerides account for 20% of the total fat mass. The carbohydrate energy ratio is adjusted to 45%, with maltodextrin as the main component, accounting for 70% of the total carbohydrate mass.

[0022] When initially administering the first formulation during the first stage, it should be diluted with water at a 1:1 ratio. The initial feeding dose is 0.5 ml per kilogram of body weight per hour, administered intermittently via a nasogastric tube.

[0023] Recommendations for supply adjustment and phase transition: Assess the patient's gastrointestinal tolerance and introduce an enteral nutrition tolerance scoring system: No abdominal pain, no vomiting, no diarrhea, 0 points; No abdominal pain, no vomiting, loose stools ≥3 times / day and 250mL≤stool volume<500mL, 1 point; Intra-abdominal pressure 15-20mmHg, 250mL≤gastric residual volume<500ml, loose stools ≥3 times / day and 500mL≤stool volume<1500mL, 2 points; Intra-abdominal pressure >20mmHg, gastric residual volume ≥500ml, loose stools ≥3 times / day and stool volume >1500mL, 5 points; Simultaneously, dynamically adjust the nutritional supply strategy based on the scoring results: 0-2 points, continue enteral nutrition, increase or maintain the original supply rate; 3-4 points, continue enteral nutrition, but slow down the supply rate, and reassess tolerance after 2 hours; ≥5 points... Enteral nutrition should be temporarily suspended. The transition from Phase 1 to Phase 2 involves focusing on symptoms such as abdominal distension, diarrhea, vomiting, and abdominal pain, while simultaneously recording the enteral nutrition tolerance score. The dosage and frequency of feeding should be increased in a stepwise manner. When the patient tolerates the target feeding amount of the first formulation for more than 24 hours, and has no symptoms of abdominal distension, diarrhea, or vomiting for 24 consecutive hours, with one bowel movement per day, and the enteral nutrition tolerance score remains consistently between 0 and 2 points, indicating good gastrointestinal tolerance, the patient can be switched to the second formulation. The target feeding amount in Phase 1 should meet 60% of the patient's basal energy requirement. Based on the patient's weight of 60 kg and the type of orthopedic joint replacement surgery, the basal energy requirement is determined to be 1800 kcal / day, therefore the target feeding amount is 1080 kcal / day. The second formulation should be initially diluted at a 1:1 ratio, with an initial feeding dose of 1.5 ml per kilogram of body weight per hour. The transition from Phase Two to Phase Three involves monitoring the patient's gastrointestinal tolerance. In addition to monitoring symptoms such as bloating, diarrhea, vomiting, and abdominal pain, bowel sound frequency monitoring is added. Enteral nutrition tolerance scores are recorded, and the amount and frequency of food intake are increased in a stepwise manner. The target feeding amount in Phase Two meets 80% of the patient's basal energy requirement, i.e., 1440 kcal / day. Plasma protein levels and nutritional status assessment criteria are introduced: Albumin (g / L) 40.0-55.0, prealbumin (mg / L) 200-400, transferrin (g / L) 2.50-4.30 are considered normal nutritional status; albumin (g / L) 30.0-39.9, prealbumin (mg / L) 160-199, transferrin (g / L) 1.50-2.49 are considered mildly inadequate nutritional status; albumin (g / L) 25.0-2... 9.9. Prealbumin (mg / L) 100-159, transferrin (g / L) 1.00-1.49, is considered moderately inadequate nutritional status; albumin (g / L) <25.0, prealbumin (mg / L) <100, transferrin (g / L) <1.00, is considered severely inadequate nutritional status. When the patient has good gastrointestinal tolerance, i.e., enteral nutrition tolerance score 0-2, self-feeding intake is 800 kcal / day, and the test indicators show albumin 32 g / L, prealbumin 160 mg / L, transferrin 1.8 g / L and hemoglobin 105 g / L, indicating the need for higher level of nutritional support, switch to the third preparation. The third preparation is not diluted, the initial dose is 2 ml per kilogram of body weight per hour, and the target feeding amount of the third stage meets 100% of the patient's basic energy requirement, i.e. 1800 kcal / day.

[0024] Monitoring and Protocol Optimization: During nutritional support, the patient's gastrointestinal tolerance was continuously monitored. Pre-set nutritional indicators were also monitored. Fasting blood glucose was maintained within the normal metabolic range of 4.4-7.8 mmol / L. When fasting blood glucose rose to 8.2 mmol / L, the proportion of carbohydrates in the current stage of the formula was reduced; when fasting blood glucose dropped to 4.0 mmol / L, the proportion of carbohydrates in the current stage of the formula was increased. Venous blood samples were collected on postoperative days 1, 3, and 7 to measure albumin, prealbumin, and hemoglobin levels. When albumin remained below 35 g / L, the protein energy ratio in the current stage of the formula was increased; when albumin was below 180 mg / L, branched-chain amino acids were supplemented; when hemoglobin was below 100 g / L, the amount of iron was increased, along with vitamin C. When the patient experienced intolerance symptoms such as abdominal distension or diarrhea, the current formula was discontinued or the patient reverted to the previous stage. Enteral nutrition formulas were dynamically recommended based on monitoring results.

[0025] In summary, this study, targeting orthopedic joint replacement surgery, divides the postoperative period into three stages based on the characteristics of slow intestinal function recovery, metabolic transition, and inflammatory response, and designs three corresponding enteral nutrition formulations. The nitrogen source, fat, and carbohydrate ratios and component sources of each formulation are clearly defined. The first formulation is administered according to specific dilution ratios, dosages, and intervals. The second and third formulations are then switched based on gastrointestinal tolerance and the time required to reach the target feeding amount. Strict adherence to symptom and indicator requirements is maintained during the switching process, while continuous monitoring of gastrointestinal responses and pre-set nutritional indicators is conducted. This dynamic recommendation of enteral nutrition formulations provides a complete and targeted nutritional management pathway.

[0026] Example 2: Phase Division: In the application scenario of nutritional management for patients after bone tuberculosis surgery, considering the physiological and metabolic characteristics of high risk of metabolic disorders and long duration of inflammatory response after bone tuberculosis surgery, the postoperative nutritional management process is divided into three step-by-step phases. The first phase is the adaptive feeding period, with a time window set at 0-24 hours after surgery; the second phase is the transitional nutrition period, with a time window set at 2-3 days after surgery; and the third phase is the comprehensive nutritional support period, with a time window set at the 4th day after surgery until discharge.

[0027] Stage-specific formulation design: Three enteral nutrition formulations were designed for each of the three stages. The first formulation, used in the first stage, uses oligopeptides and free amino acids as the main nitrogen source at a mass ratio of 5:1, with the nitrogen source provided by oligopeptides and free amino acids accounting for 85% of the total nitrogen source. Glutamine is added, and the fat energy ratio is controlled at 15%, with the fat source being medium-chain triglycerides. The carbohydrate energy ratio is adjusted to 70%, with maltodextrin as the main component, and also containing rice flour and glucose, accounting for 95% of the total carbohydrate mass. The second formulation is used in the second phase: It uses whole protein as the primary nitrogen source, specifically hydrolyzed whey protein, which provides 55% of the total nitrogen. It is also supplemented with soluble dietary fiber at a rate of 3g / 100g. The fat energy ratio is adjusted to 30%, with the fat source being a mixture of medium-chain triglycerides and vegetable oil, where medium-chain triglycerides account for 40% of the total fat mass. The carbohydrate energy ratio is adjusted to 60%, with maltodextrin as the main component, accounting for 90% of the total carbohydrate mass. The third formulation is used in the third stage: it uses whole protein as the nitrogen source entirely. The whole protein is composed of casein, hydrolyzed whey protein, and soy protein isolate, with the three components accounting for 40%, 40%, and 20% of the total mass of the whole protein, respectively. It is also combined with soluble dietary fiber. The fat energy ratio is adjusted to 35%, and the fat source is a mixture of medium-chain triglycerides and vegetable oil, with medium-chain triglycerides accounting for 40% of the total fat mass. The carbohydrate energy ratio is adjusted to 55%, with maltodextrin as the main component, accounting for 90% of the total carbohydrate mass.

[0028] When initially administering the first formulation in the first stage, the dilution ratio of the first formulation to water is 3:1, and the initial feeding dose is 1.5 ml per kilogram of body weight per hour, administered intermittently via a nasogastric tube.

[0029] Recommendations for supply adjustment and phase transition: Assess patients' gastrointestinal tolerance using an enteral nutrition tolerance scoring system: 0 points for no abdominal pain, no vomiting, and no diarrhea; 1 point for no abdominal pain, no vomiting, and loose stools ≥3 times / day with a volume of 250mL ≤ stool < 500mL; 2 points for intra-abdominal pressure 15-20mmHg, gastric residual volume ≥ 500mL, and loose stools ≥3 times / day with a volume of 500mL ≤ stool < 1500mL; 5 points for intra-abdominal pressure > 20mmHg, gastric residual volume ≥ 500ml, and loose stools ≥3 times / day with a volume of > 1500mL. Simultaneously, dynamically adjust the nutritional supply strategy based on the scoring results: 0-2 points: continue enteral nutrition, increasing or maintaining the original supply rate; 3-4 points: continue enteral nutrition but slow the supply rate, reassessing tolerance after a 2-hour interval; ≥5 points: suspend enteral nutrition supply, transitioning from the first phase to the second phase. Phase Two Transition: Focus on observing symptoms of abdominal distension, diarrhea, vomiting, and abdominal pain, while recording the enteral nutrition tolerance score. Gradually increase the feeding dosage and frequency. The target feeding amount in Phase One should meet 80% of the patient's basal energy requirement. The patient weighs 70 kg, and considering the type of bone tuberculosis surgery, the basal energy requirement is determined to be 2100 kcal / day. Therefore, the target feeding amount in Phase One is 1680 kcal / day. When the patient tolerates this target feeding amount for more than 24 hours, and has no symptoms of abdominal distension, diarrhea, or vomiting for 24 consecutive hours, has 3 bowel movements per day, and the enteral nutrition tolerance score is maintained at 0-2 points, indicating good gastrointestinal tolerance, switch to the second formulation. The second formulation is initially diluted at a ratio of 2:1, and the initial feeding dose is 2 ml per kilogram of body weight per hour. The target feeding amount in Phase Two should meet 100% of the patient's basal energy requirement, i.e., 2100 kcal / day. The transition from Phase Two to Phase Three involves monitoring the patient's gastrointestinal tolerance. In addition to monitoring symptoms such as bloating, diarrhea, vomiting, and abdominal pain, bowel sound frequency monitoring is added. Enteral nutrition tolerance scores are recorded, and the amount and frequency of food intake are increased in a stepwise manner. Plasma protein levels and nutritional status assessment criteria are introduced: Albumin (g / L) 40.0-55.0, prealbumin (mg / L) 200-400, transferrin (g / L) 2.50-4.30 are considered normal nutritional status; albumin (g / L) 30.0-39.9, prealbumin (mg / L) 160-199, transferrin (g / L) 1.50-2.49 are considered mildly inadequate nutritional status; albumin (g / L) 25.0-29.9, prealbumin (mg / L) 100- 159. Transferrin (g / L) 1.00-1.49 is considered moderately inadequate; albumin (g / L) <25.0, prealbumin (mg / L) <100, transferrin (g / L) <1.00 is considered severely inadequate. When the patient has good gastrointestinal tolerance (enteral nutrition tolerance score 0-2, self-feeding intake 1200 kcal / day), and the test indicators show albumin 30 g / L, prealbumin 150 mg / L, transferrin 1.2 g / L, and hemoglobin 100 g / L, indicating the need for higher levels of nutritional support, the third preparation is switched to. The third preparation is undiluted, with an initial dose of 2.5 ml per kilogram of body weight per hour. The target feeding amount for the third stage meets 120% of the patient's basal energy requirement, i.e., 2520 kcal / day.

[0030] Monitoring and Protocol Optimization: During nutritional support, continuously monitor the patient's gastrointestinal tolerance, promptly identify and address discomfort such as bloating and diarrhea, and monitor pre-set nutritional indicators. Fasting blood glucose should be maintained within the normal range of 4.4-7.8 mmol / L. If the patient's fasting blood glucose reaches 8.5 mmol / L, reduce the carbohydrate ratio in the current stage of the formula; if fasting blood glucose drops to 3.8 mmol / L, increase the carbohydrate ratio. Venous blood samples should be collected on postoperative days 1, 3, and 7 to test albumin, prealbumin, and hemoglobin. If albumin remains below 35 g / L, increase the protein energy ratio in the current stage of the formula; if prealbumin is below 180 mg / L, supplement with branched-chain amino acids; if hemoglobin is below 100 g / L, increase the amount of iron and supplement with vitamin C. If intolerance occurs, immediately discontinue the current formula or revert to the previous stage formula. Dynamically recommend enteral nutrition formulas based on monitoring results.

[0031] In summary, considering the high risk of metabolic disorders and prolonged inflammation in postoperative patients with bone tuberculosis, the postoperative nutritional management process was divided into three steps. Three suitable enteral nutrition formulations were designed, with the proportions and sources of each formulation clearly defined. The first formulation was administered according to specific dilution ratios and dosages. The second and third formulations were then switched based on gastrointestinal tolerance, self-feeding volume, and examination indicators, with the switching conditions meeting the standards. Gastrointestinal reactions and pre-set nutritional indicators were monitored throughout the process, and enteral nutrition formulations were dynamically recommended, providing a scientific and physiologically appropriate nutritional management plan.

[0032] The above description is merely a preferred embodiment of the present invention and is not intended to limit the present invention in any way. Although the present invention has been disclosed above with reference to preferred embodiments, it is not intended to limit the present invention. Any person skilled in the art can make some modifications or alterations to the above-disclosed technical content to create equivalent embodiments without departing from the scope of the present invention. Any simple modifications, equivalent changes and alterations made to the above embodiments based on the technical essence of the present invention without departing from the scope of the present invention shall still fall within the scope of the present invention.

Claims

1. A method for nutritional formulation recommendation after surgery, characterized in that, The specific steps of the recommendation method are: Stage division: the postoperative nutrition allocation process is divided into three ladder stages, the first stage is an adaptive feeding period, the second stage is a transitional nutrition period, and the third stage is a comprehensive nutrition support period; Stage formula design: three enteral nutrition formulas are designed for the three stages respectively, the first formula is used for the first stage, low oligopeptide and free amino acid are used as the main nitrogen source, the second formula is used for the second stage, whole protein is used as the main nitrogen source, and the third formula is used for the third stage, and whole protein is used to provide nitrogen source; The first formula is fed intermittently through a nasogastric tube; Supply adjustment and stage conversion recommendation: when the patient tolerates the target feeding amount of the first formula for more than 24 hours and the gastrointestinal tract is well tolerated, the second formula is converted; when the patient's gastrointestinal tract is well tolerated, the self-feeding amount is less than 60% of the target amount, and the examination index indicates that higher level of nutritional support is needed, the third formula is converted; Monitoring and scheme optimization: continuously monitor the patient's gastrointestinal tolerance, and monitor the nutritional preset index at the same time, when intolerance occurs, stop the current formula supply or return to the last stage formula type, and dynamically recommend enteral nutrition formula according to the monitoring result.

2. The method for nutritional formula recommendation after surgical procedures according to claim 1, characterized in that, In the three stage division, the recovery degree of intestinal function, the transition process of metabolic state and the intensity of inflammatory reaction are divided; the first stage is the adaptive feeding period, the time window is set to 0-24 hours after operation; the second stage is the transitional nutrition period, the time window is set to 2-3 days after operation; the third stage is the comprehensive nutrition support period, the time window is set to the 4th day after operation to discharge.

3. The method for nutritional formula recommendation after surgical procedures according to claim 1, characterized in that, In the enteral nutrition formula design, the first formula: more than 80% of the nitrogen source is provided by oligopeptide and free amino acid, glutamine is added, the fat energy supply ratio is adjusted to be less than or equal to 15%, and the carbohydrate energy supply ratio is adjusted to be less than or equal to 70%; the second formula: 50%-80% of the nitrogen source is provided by whole protein, and soluble dietary fiber is added, the amount of soluble dietary fiber added is 2-4g / 100g, the fat energy supply ratio is adjusted to be 20%-30%, and the carbohydrate energy supply ratio is adjusted to be 50%-60%; the third formula: whole protein is used as the nitrogen source, and soluble dietary fiber is added, the fat energy supply ratio is adjusted to be 25%-35%, and the carbohydrate energy supply ratio is adjusted to be 45%-55%.

4. The method for nutritional formula recommendation after surgical procedures according to claim 3, characterized in that, In the enteral nutrition formula design, the mass ratio of oligopeptide to free amino acid in the first formula is 3-5:1; the whole protein of the second formula is casein or hydrolyzed whey protein; the whole protein of the third formula is a mixture of casein, hydrolyzed whey protein and soybean protein isolate, and the mass proportion of casein, hydrolyzed whey protein and soybean protein isolate in whole protein is 30%-40%, 30%-40% and 20%-30% respectively.

5. The method for nutritional formula recommendation after surgical procedures according to claim 3, characterized in that, The main component of the carbohydrates in the first preparation, the second preparation and the third preparation is malt dextrin, wherein the proportion of malt dextrin in the total mass of the carbohydrates in the second preparation and the third preparation is 70%-90%, and the main component of the carbohydrates in the first preparation is malt dextrin, and the first preparation contains rice powder and glucose, and the total proportion of the carbohydrates is 80%-95%; the fat source of the first preparation is medium-chain triglyceride; the fat source of the second preparation and the third preparation is a mixture of medium-chain triglyceride and vegetable oil, and the proportion of medium-chain triglyceride in the total mass of the fat is 20%-40%.

6. The method for nutritional formula recommendation after surgical procedures according to claim 1, wherein, The dilution ratio of the first preparation with water is 1:1-3:1 when the first preparation is initially supplied, and the initial feeding dose is 0.5-1.5 milliliters per kilogram of body weight per hour; the interval time of intermittent feeding is 2-3 hours, and the duration of each feeding is 30-50 minutes.

7. The method for nutritional formula recommendation after surgical procedures according to claim 1, characterized in that, In the supply adjustment and stage conversion recommendation, when monitoring the gastrointestinal tolerance of the patient, the enteral nutrition tolerance score standard is used for quantitative evaluation, and in the first stage, the symptoms of abdominal distension, diarrhea, vomiting and abdominal pain are monitored, and in the second stage and the third stage, on the basis of monitoring the symptoms of abdominal distension, diarrhea, vomiting and abdominal pain, the frequency of borborygmus is monitored, and the enteral nutrition tolerance score standard is as follows: 0 points are scored when there is no abdominal pain, no vomiting and no diarrhea; 1 point is scored when there is no abdominal pain, no vomiting, and 3 or more times of loose stools per day, and the stool volume is 250-500 milliliters; 2 points are scored when the intra-abdominal pressure is 15-20 mmHg, the gastric residual volume is 250-500 milliliters, there are 3 or more times of loose stools per day, and the stool volume is 500-1500 milliliters; 5 points are scored when the intra-abdominal pressure is greater than 20 mmHg, the gastric residual volume is greater than 500 milliliters, there are 3 or more times of loose stools per day, and the stool volume is greater than 1500 milliliters; before the first preparation is converted to the second preparation, the following conditions must be met simultaneously: the enteral nutrition tolerance score of the patient is maintained at 0-2 points for 24 consecutive hours; there are no symptoms of abdominal distension, diarrhea and vomiting for 24 consecutive hours; the number of daily bowel movements is 1-3 times; the second preparation is diluted at a ratio of 1:1-2:1 when it is initially supplied, and the initial feeding dose is 1.5-2 milliliters per kilogram of body weight per hour; Before the second preparation is converted to the third preparation, the following conditions must be met simultaneously: the gastrointestinal tolerance of the patient is good, and the enteral nutrition tolerance score is maintained at 0-2 points; the amount of self-feeding is less than 60% of the target amount; The examination index indicates that higher level of nutritional support is needed, and the plasma egg white number is used as the quantitative judgment standard: 30.0-39.9 g / L of albumin, 160-199 mg / L of prealbumin and 1.50-2.49 g / L of transferrin protein indicate mild nutritional deficiency; 25.0-29.9 g / L of albumin, 100-159 mg / L of prealbumin and 1.00-1.49 g / L of transferrin protein indicate moderate nutritional deficiency; <25.0 g / L of albumin, <100 mg / L of prealbumin and <1.00 g / L of transferrin protein indicate severe nutritional deficiency, the third preparation is not diluted, and the initial dose is 2-2.5 milliliters per kilogram of body weight per hour.

8. The method for nutritional formula recommendation after surgical procedures according to claim 1, wherein, The feeding adjustment and stage conversion recommendation, the setting standard of each stage target feeding amount is that the first stage target feeding amount meets 60%-80% of the patient's basic energy requirement, the second stage target feeding amount meets 80%-100% of the patient's basic energy requirement, and the third stage target feeding amount meets 100%-120% of the patient's basic energy requirement. The patient's basic energy requirement is determined according to the body weight and the type of operation.

9. The method for nutritional formula recommendation after surgical procedures according to claim 1, wherein, In the monitoring and scheme optimization, when the nutritional preset index is monitored, the fasting blood glucose is maintained in the normal metabolism range of 4.4-7.8 mmol / L, when the fasting blood glucose is higher than 7.8 mmol / L, the proportion of carbohydrates in the preparation of the current stage is reduced, when the fasting blood glucose is lower than 4.4 mmol / L, the proportion of carbohydrates in the preparation of the current stage is increased, and on the first day, the third day and the seventh day after the operation, venous blood is collected to detect albumin, prealbumin and hemoglobin indexes, when the albumin is continuously lower than 35 g / L, the energy supply ratio of protein in the preparation of the current stage is increased, when the current albumin is lower than 180 mg / L, the content of branched chain amino acids is supplemented, and when the hemoglobin is lower than 100 g / L, the addition amount of trace element iron is increased, and vitamin C is matched.

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