肝胆手术患者术前营养风险筛查及营养支持状况

Preoperative nutritional risk screening and application of nutritional support in patients undergoing hepatobiliary surgery

目的研究肝胆外科住院患者术前营养风险发生率以及营养支持的临床应用状况，为合理进行术前营养支持提供参考依据。方法采用定点连续抽样，选择2009年1月至2011年4月在江门新会会城医院新住院的肝胆外科患者为研究对象，于入院次日早晨使用营养风险筛查2002（NRS2002）对其进行营养风险筛查，并调查其手术前的营养支持状况，分析营养风险和营养支持之间的关系。NRS2002≥3分为有营养风险，营养治疗包括肠外和肠内营养。结果共有125例患者人选并全部完成NRS2002筛查，NRS2002的适用率为100％。营养风险总的发生率为20．8％，其中≥65岁患者的营养风险发生率为37．8％，高于〈65岁者的11．3％（P〈0．05）。在26例有营养风险的患者中，有14例（53．8％）接受了营养支持；在无营养风险的99例患者中，有5例（5．1％）接受了营养支持。所有患者纯肠外和纯肠内营养的应用比例为2．0：1。结论NRS2002适用于肝胆外科住院患者的营养筛查。肝胆外科部分住院患者术前存在营养风险，临床中营养支持仍存在某些不合理性，应推广和应用基于证据的营养支持指南以改善此状况。

Objective To provide reference for rational nutritional support by investigating the incidence of preoperative nutritional riskd and the clinical use of nutritional support in patients undergoing hepatobiliary surgery. Methods The patients who had been hospitalized due to hepatobiliary surgery during the period of January 2009 to April 2011 were consecutively enrolled in this study. Nutritional Risk Screening 2002 （ NRS2002 ） was conducted on the next morning after admission and the preoperative nutritional support was surveyed. The relationship of nutritional risks with nutritional support was analyzed. Nutritional risk was defined as NRS2002 score ≥ 3. Nutritional therapy included parenteral and enteral nutrition. Results A total of 125 patients were enrolled, and NRS2002 scoring was conducted in all the patients. The total incidence of nutritional risk was 20. 8%. The nutritional risk was significantly higher in the elderly patients （≥ 65 years old ） than in those younger than 64 years （ P〈 0.05 ）. 14 of 26 patients （ 53.8% ） with a score t〉3 received nutrition support while 5 of 26 （ 5.1% ）with a score 〈 3 received nutritional support. The ratio of parenteral nutrition to enteral nutrition was 2. 0 ： 1. Conclusions NRS2002 is suitable for the assessment of nutritional risk in patients undergoing hepatobiliarv surgery. A proportion of patients were at nutritional risk. The use of nutritional support is currently somehow inappropriate. Evidence-based guidelines are required to improve this situation.