潍坊某三甲医院早、中期（Ⅰ、Ⅱ、Ⅲ期）胃肠道癌患者的营养风险、营养不足发生率和营养支持情况调查

Nutritional risks, undernutrition, and nutrition support among inpatients with early and middle stage gas- trointestinal cancers in a tertiary hospital in Weifang, Shandong Province

目的调查潍坊某三甲医院接受根治手术的早、中期（Ⅰ、Ⅱ、Ⅲ期）胃肠道癌患者的营养风险、营养不足和营养支持应用情况。方法采用定点连续抽样的方法调查潍坊市某三甲医院2010年12月至2011年8月、2011年11月至2012年10月肿瘤外科、肛肠外科、普通外科住院患者8390例，进入录入登记。排除住院不足24h、年龄〈18岁或〉90岁、神志不清、拒绝参加研究的患者153例，收录8237例。排除不符合预定诊断的病例后，筛出手术及病理证实为早、中期的胃肠道癌患者300例（3．6％，300／8390）。在患者入院后48h内采用营养风险筛查2002（NRS2002）进行营养风险筛查，调查营养不足发生率，记录患者住院期间的营养支持应用状况。结果在300例人选患者中，共有早中期胃癌根治术患者141例，早中期结直肠癌根治术患者159例。总营养风险发生率为61．7％（185／300）。以NRS2002中营养受损部分的评分t〉3分来计算营养不足发生率为12．3％（37／300），以体重指数〈18．5kg／m。计算营养不足发生率为10．O％（30／300）。有营养风险的185例患者中，165例接受了营养支持（89．2％）；无营养风险的115例患者中，99例接受了营养支持（86．1％）。肠外营养与肠内营养的应用例数比为82：1。能量摄人为（78．1±24．8）kJ／（kg·d）[（18．6±5．9kcal／（kg·d）]，氮摄入量为（0．10±0．06）g／（kg·d），热氮比为（244±164）：1。结论早、中期（Ⅰ、Ⅱ、Ⅲ期）胃肠道癌患者营养风险发生率为61．7％，营养不足发生率为10．0％-12．3％。对这部分患者的营养支持很不规范，无营养风险患者的营养支持率高达86．1％。还需要在医院开展大范围、反复的“肠内与肠外营养临床诊疗指南”培训。

Objective To investigate the nutritional risk, undernutrition, and nutrition support in inpa- tients with early and middle stage gastrointestinal cancer undergoing radical surgery in a tertiary hospital in Wei- fang, Shandong Province. Methods A total of 8390 inpatients who were treated in the departments of oncological surgery, enterohepatic surgery, and general surgery in our hospital were consecutively recorded from December 2010 to August 2011 and from November 2011 to October 2012. After 153 patients were excluded for hospital length of stay less than 24 hours, age less than 18 years old or more than 90 years old, obnubilation, and/or refusal to participate in the research, 8237 patients were sampled. After patients who did not meet the scheduled diagnosis were excluded, 300 pathology-confirmed patients with early or middle stage gastrointestinal cancer were enrolled. Nutritional Risk Screening 2002 （ NRS 2002） was performed within the first 48 hours after admission and nutrition support was evaluated until the discharge. Results A total of 300 early and middle stage gastrointestinal cancer patients （ 141 cases of gastric cancer and 159 cases of colorectal carcinoma） who underwent radical surgery met the inclusion criteria. Among them 185 （61.7%） were at nutritional risk. The undernutrition rate was 12. 3% （37/300） if evalu- ated from the score of nutritional defect part of NRS 2002, and 10. 0% （30/300） if based on body mass index 〈 18.5 kg/m2. Totally 165 patients （89.2%） at nutritional risk and 99 patients （86. 1% ） without nutritional risk received nutrition support. The average ratio of parenteral nutrition to enteral nutrition was 82：1. The intake of calories was （78. 1 ±24.8） kJ/（kg · d） [ （18.6 ±5.9）kcal/（kg ·d）] and that of nitrogen was （0. 10±0.06） g/（kg ·d）, yielding a ratio of calories vs. nitrogen of （244 ± 164） ：1. Conclusions Inpatients with early and middle stage gastro- intestinal cancer tend to have high nutritional risk. The undernutrition rate is 10%-12. 3% in this population. Mean- while, the application of nutrition support should be further standardized, particularly for patients without nutritional risk.