营养风险筛查与干预在食管癌患者快速康复外科治疗中的应用

Application of nutrition risk screening and intervention for esophageal carcinoma patients with fast-track surgery

目的：探讨基于营养风险筛查（ nutritional risk screening，NRS）与干预的快速康复外科（ fast track surgery，FTS）策略在食管癌患者围手术期治疗中的临床应用。方法160例食管癌患者随机分为两组。FTS组术前采用营养风险筛查2002（ NRS2002）方法进行评估，并在围手术期针对干预治疗（ FTS组，80例）；对照组按传统围手术期处理方法（ conventional perioperative manage-ment）治疗（ CPM组，80例）。比较两组患者术后首次排气、排便时间、拔除胸腔引流管时间、住院时间以及术后并发症等情况。结果 FTS组术后首次排气时间[（62.7±2.9）h vs（95.8±3.0）h ]、首次排便时间[（3.56±1.46）d vs（5.08±1.85）d ]、拔除胸腔引流管时间[（2.93±0.36）d vs （4.66±0.26）d ]、术后住院时间[（8.67±0.85）d vs（11.61±1.21）d ]及总并发症发生率[7.50％（6/80）vs 18.75％（15/80）]等均少于CPM组，差异有统计学意义（ P﹤0.05）。结论围手术期应用基于NRS与干预的FTS策略，可有效促进食管癌患者康复，缩短住院时间。

Objective To explore the clinical application of fast track surgery（FTS）pathways based on nutrition risk screening（ NRS）and intervention for esophageal carcinoma patients perioperatively. Methods A total of 160 patients with esophageal carcinoma were randomly divided into 2 groups. Patients with FTS received nutritional risk screening（ NRS 2002 ）and interventions perioperatively（ n =80,FTS group）. Other patients received conventional perioperative management（ CPM）according to routine proto-cols（n=80,CPM group）. The time of first passage of flatus and defecation,time of drainage removal,hos-pital stay and postoperative complications were recorded and compared respectively. Results Patients in the FTS group achieved better results than those in the CPM group in time of first passage of flatus [（95. 8 ± 3. 0）h vs（62. 7 ± 2. 9）h],time of first passage of defecation[（5. 08 ± 1. 85）d vs（3. 56 ± 1. 46）d],time of drainage removal[（4. 66 ± 0. 26）d vs（2. 93 ± 0. 36）d],hospital stay[（11. 61 ± 1. 21） d vs（8. 67 ± 0. 85）d]and postoperative complication rate[7. 50%（6/80）vs 18. 75%（15/80）]. There were significant differences in these indexes between the two groups（P﹤0. 05） Conclusion Based on NRS and intervention,FTS pathways can accelerate recovery and shorten hospitalization for esophageal car-cinoma patients.