宁波某三甲医院胃结直肠癌I～Ⅲ期患者营养风险、不足、支持情况：前瞻性调查

The prospective investigation of nutritional risk and undernutrition and the nutrition support in stageⅠ -Ⅲ gastro-colorectal cancer patients in a tertiary hospital in Ningbo

目的调查宁波某三甲医院外科病房的全部入院患者的营养风险发生率及I～Ⅲ期胃结直肠癌患者的营养风险、营养不足发生率和营养支持应用情况。方法应用定点连续采样的方法，对2012年1至12月胃肠外科、普通外科两个病房能够做营养风险筛查2002的全部住院患者，均收集基础资料录入电子数据收集系统（EDC）。其中277例I～Ⅲ期胃结直肠癌患者按计划调查营养风险、营养不足的发生率；全程记录住院期间是否接受肠外肠内营养支持，调查输入热量、氨基酸、碳水化合物及脂肪的入量和天数，录入EDC，经核查后进行合适的统计分析。结果连续采样的3513例住院患者，总营养风险发生率为17．28％，符合预定诊断的调查对象277例患者，营养风险发生率为45．49％。从营养风险筛查2002中营养缺失部分评分的多指标计算营养不足的发生率为13．36％，按单指标计算（体重指数〈18．5kg/㎡，一般情况差）营养不足的发生率为9．03％，多指标与单指标来源的营养不足发生率差距为4．33％。有营养风险患者的营养支持率为93．65％；无营养风险患者的营养支持率为61．59％；肠外营养与肠内营养的比例为2．67：1，部分肠外营养与肠内营养支持极不规范。结论本院I～Ⅲ期胃结直肠癌患者营养风险发生率较高，营养支持应用不规范，临床医师需继续学习中华医学会“肠内与肠外营养临床诊疗指南”。

Objective To investigate the prevalence of nutritional risk and undernutrition and the nutri tion support in stage Ⅰ -Ⅲ gastro-colorectal cancer patients in a tertiary hospital in Ningbo, Zhejiang province. Methods The clinical data of all patients in the wards of general surgery and gastrointestinal surgery were con secutively recorded into the electronic data collection system from January 2012 to December 2012, during which the prevalence of nutritional risk was analyzed based on 3513 consecutive cases. For 277 patients with stage Ⅰ -Ⅲ gastro-colorectal cancer, the prevalence of nutritional risk and undernutrition were analyzed. Both the accurate amount and duration of nutritional support ingredients （ calories, amino acids, carbohydrates, and fat intake ） were recorded until patients＇ discharge. The recorded electronic data were then statistically ana lyzed. Results The total nutritional risk rate was 17.28% in the consecutively sampled 3513 cases. In 277patients meeting the diagnostic criteria, the nutritional risk rate was 45.49%. The undernutrition rate was 13.36% by multi-item standard （based on Nutritional Risk Screening 2002 nutrition disorder score ） and 9.03% by one item standard （with body mass index 〈 18.5 kg/m2 and poor generally condition） , respective ly. The difference gap was 4. 33%. The nutrition support rate was 93.65% in patients with nutrition risk and 61.59% in patients without nutrition risk. The average ratio between parenteral nutrition and enteral nutrition was 2. 67： 1. The total amounts of parenteral calorie intake and nitrogen intake were insufficient. Conclusions The rate of nutritional risk in the stage Ⅰ -Ⅲ gastro-colorectal cancer patients is relatively high in this tertiary hospital. The application of nutrition support has not been standardized. More reasonable nutrition support should be promoted in this hospital in accordance with the Enteral and Parenteral Nutrition Clinical Practice Guidelines of the Chinese Medical Association.