理想的营养支持效果基于实施正确治疗策略，包括对适合的病人在恰当的时机提供合理的能量与营养素，而营养风险与营养不良评估对于确定病人能否从营养治疗中获益是重要的。国际上多个危重病学会颁布的相关营养支持指南，均明确推荐肠内营养作为营养供给途径效果优于肠外营养，并且应该及早实施。对于不能耐受充分肠内营养的外科病人，添加或应用肠外营养也是常需要考虑的选择，但肠外营养开始的时机是近年来争议的问题之一，医生在选择时应该针对病人的具体病情，如严重程度、是否存在营养风险等因素，权衡肠外营养可能带来的利弊再最终做出选择。早期开始肠内营养与避免过早积极应用肠外营养得到当今较普遍的认同。提供充分的能量和营养素是外科病人围手术期营养供给的原则，以减少手术与创伤导致的分解代谢及营养丢失。在接受早期肠内营养的围手术期病人，关注与评估实际喂养量比处方量更为重要。同时注意应激状态下的代谢改变，避免肠外营养时的过度喂养。应用营养支持管理方案将有助于围手术期外科病人更好的实现营养支持的预计目标。

Management of perioperative nutrition support        XU Yuan. Beijing Tongren Hospital Affiliated to Capital Medical University，Beijing 100730，China
Abstract    Optimal nutrition support in the patients perioperatively should based on right nutritional therapeutic strategies，for right patients，at right time and under right dose. The nutrition risk and malnutrition assessment are important to identify which patients may benefit from nutritional intervention. Several nutrition guidelines published by the societies such as ASPEN、ESPEN、German Society for Nutritional Medicine (DGEM)，Australian and New Zealand Intensive Care Society (ANZICS) and Canadian Clinical Practice Guidelines (CPGs) in the past decade，the recommendations to use enteral route prefer to parenteral for delivery of nutrition if possible is clear，and more benefit if it starts earlier，doctor will have to weigh the safety and benefits of initiating PN in patients who not tolerating EN well and the host of factors，like nutrition risk，severity of disease. Optimal timing of nutrition support is still remains a controversial topic in critically ill patients，but early enteral feeding and later parenteral supplement is recommended generally. The optimal dosing of nutritional delivery in surgical patients are providing sufficient energy and protein to minimize the catabolic loss associated with stress，injury (surgery) . While also avoiding the problems associated with overfeeding，especially during parenteral nutrition. In patients with enteral feeding，it is more important and necessary to calculate and evaluate actual amount of nutrition supply but not the dose of prescription. For best practice of nutrition support，a standardized EN/PN protocols will help in the effects of shortening duration of mechanical ventilation and a reduced mortality，so a good strategies and well management are key points of reaching the goal of optimal nutrition support in surgical patients perioperatively.