口腔颌面部肿瘤患者营养风险筛查和营养治疗

Nutritional risk screening and enteral nutrition in patients with oral and maxillofacial cancers

目的:运用营养风险筛查(NRS2002)对口腔颌面部肿瘤患者进行营养风险筛查,评估NRS2002在口腔颌面部肿瘤患者中的应用情况;同时对筛查出具有营养风险的患者进行肠内营养治疗,观察治疗效果。方法:收集59例口腔颌面部肿瘤住院患者为研究对象,询问病史、近期进食情况及体重变化情况,测量身高、体重,并测定血红蛋白、淋巴细胞计数、血清白蛋白和前白蛋白。参照NRS2002对患者的具体要求,在手术前和手术后1d及7d分别对患者进行营养风险筛查。将术后筛查出有营养风险的患者随机分为实验组与对照组,进行营养干预。比较营养治疗7d后各项生化指标的变化。采用SPSS11.5软件包对结果进行t检验和χ2检验。结果:术前患者营养风险的检出率为27.1%,术后1d则提高到71.2%。与术前相比,术后营养风险显著上升(P<0.05),且患者血红蛋白、淋巴细胞计数、血清白蛋白、前白蛋白在术后均有显著下降(P<0.01)。营养干预前,实验组与对照组营养生化指标无显著性差异(P>0.05);营养干预7d后,对照组患者血液生化指标中除血红蛋白略有下降外,淋巴细胞计数、血清白蛋白、前白蛋白较干预前略有上升,其中前白蛋白显著升高(P<0.05)。实验组患者血液生化指标除血红蛋白略有下降外,淋巴细胞计数、血清白蛋白、前白蛋白较干预前均显著提高(P<0.05);营养干预后,再次进行营养风险筛查发现,与对照组相比,实验组干预后的NRS2002评分显著下降(P<0.05)。结论:NRS2002能方便、快捷地反映口腔颌面部肿瘤住院患者手术前的营养风险,且术后有针对性的营养治疗能显著提高患者的营养状况,减少感染性并发症,改善预后。

PURPOSE： To screen the nutritional risk of patients with oral and maxillofacial cancers using NRS2002 and evaluate the clinical usefulness of NRS2002.Meanwhile,nutritional support was given after screening and the effect was evaluated.METHODS： Fifty-nine patients with oral and maxillofacial cancers were enrolled in this study.The medical history and the intake condition of all patients were recorded,body weight and height were measured.The serum hemoglobin（Hb）,lymphocyte count（LC）,albumin（Alb）,pre-albumin（PA） of the patients were detected.According to the requirements of NRS2002,the patients were screened before and after surgery.The patients with nutritional risks were divided into experimental group and control group randomly.The blood biochemical parameters in the two groups were compared after nutritional intervention.The data was analyzed by student＇s t test and Chi-square test with SPSS11.5 software package.RESULTS： Nutritional risk pre-operatively was 27.1% while the figure increased to 71.2% after operation（P﹤0.05）.Compared to pre-operation,nutritional risk increased significantly.Hb,LC,Alb and PA decreased significantly（P﹤0.01）.Before nutritional intervention,there was no difference of the biochemical stats between the patients in the experimental group and the control group（P﹤0.05）.After 7 days＇ treatment,the biochemical parameters except Hb and PA increased significantly in the control group.In the experimental group,LC,Alb and PA increased significantly（P〉0.05）,especially Alb（P﹤0.01）,but Hb decreased.Compared with the control group,the NRS 2002 score decreased significantly in the experimental group after nutritional intervention.CONCLUSIONS： NRS2002 can reflect the nutritional risk of the patients with oral and maxillofacial cancers conveniently and swiftly.Nutritional support after operation can significantly increase the nutritional status of the patients,reduce the infectious complications and improve the prognosis.