胃肠道大手术患者营养风险筛查及营养支持效果对比研究

Nutritional Risk Screening and Comparison The Effect of Nutritional Support Among The Patients with Gastroin-testinal Major Surgery

目的以营养风险筛查工具2002(NRS 2002)调查双流县人民医院普通外科住院行胃肠道大手术患者的营养风险发生率,营养支持使用状况及其与临床结局之间的关系。方法采取定点抽样,选择2010年3月至2014年3月期间双流县第一人民医院普通外科住院行胃肠道大手术患者,用NRS 2002进行营养风险筛查,记录营养支持使用情况及相关临床结局指标,分析临床营养支持与患者临床结局之间的关系。本研究选择术后并发症及住院时间作为临床结局指标。结果共有130例患者符合研究纳入标准,其中112例完成了营养风险筛查。营养风险发生率为75.9%(85/112),营养支持率为50.9%(57/112),营养支持方式均为胃肠外营养。术后并发症发生率为46.4%(52/112);其中有营养风险且给予了营养支持的患者并发症发生率为41.7%(15/36),而在有营养风险但未进行营养支持的患者中并发症发生率高达73.5%(36/49),2组间的差异有统计学意义(P=0.002);在无营养风险的患者中,术后并发症发生率仅为3.7%(1/27)。结论 NRS 2002因其具备无创、简便的特点,适用于住院行胃肠道大手术的患者;胃肠道大手术患者因其疾病代谢的特殊性,具有较高的营养风险;对存在营养风险的胃肠道大手术患者进行合理的营养支持能够减少术后并发症发生的概率,改善患者的预后。

Objective To investigate the prevalence of the nutritional risks, the relationship between application of nutritional support and the clinical outcome of patients with gastrointestinal major surgery in the Frist People's Hospital of Shuangliu. Methods Gastrointestinal major surgery patients in Department of General Surgery in the Frist People's Hospital of Shuangliu from March 2010 to March 2014 were consecutively enrolled. Patients who provided informed consent were screened by NRS 2002, tracking nutrition support status and analysis the relationship between nutrition support and clinical outcome. In this study, the clinical outcome index included postoperative complications and hospitalization time. Results There were totally 130 cases enrolled, 112 cases completed assessment by NRS 2002.The prevalence of nutritional risk was 75.9%(85/112), there were totally 57 patients(50.9%) received nutrition support, and all for parenteral nutrition. The prevalence of postoperative complication was 46.4%(52/112). The prevalence of postoperative complication in patients who had nutritional risk and received nutritional support was 41.7%(15/36), whereas, in patients who had nutritional risk but not received nutritional support was 73.5%(36/49), there was statistically signifi cant difference between the 2 groups(P=0.002). In patients who not had nutritional risk, the postoperative complication rate was only 3.7%(1/27). Conclusions Because of noninvasive and easy to operate, NRS 2002 are adpted to hospitalized patients with gastrointestinal major surgery. Because of the specific of disease metabolism, the higher nutritional risk occurres in patients with gastrointestinal major surgery, appropriate nutritional support for this kinds of patients can reduce the incidence of postoperative complication, and improve the prognosis.