全程营养管理模式对头颈恶性肿瘤围手术期营养的影响研究

The Effect of Full Nutritional Management Model on Perioperative Nutritional Status in Patients with Head and Neck Malignancies

目的探讨全程营养管理模式对头颈恶性肿瘤患者围手术期营养的影响。方法选择2012年3月-2013年6月住院的头颈恶性肿瘤患者64例,随机分成对照组和研究组各32例。对照组给予头颈肿瘤常规饮食指导,研究组由营养支持小组给予全程营养管理,手术前后（入院后及术后3 d）并采用营养风险筛查量表2002（NRS2002）对其手术前后的营养状况进行筛查、评定。同时观察比较两组患者术后并发症、统计住院时间及费用。结果 29.7%～48.4%的头颈恶性肿瘤患者在围手术期的不同阶段存在营养风险,通过实施全程营养管理模式,研究组术后营养风险显著低于对照组（P〈0.01）;体质量指数、肱三头肌皮褶厚度、上臂中段肌围、前白蛋白、血肌酐方面均较对照组有明显改善（P〈0.01）;术后并发症低于对照组（P〈0.05）;住院时间及住院费用方面均显著低于对照组（P〈0.001）。结论全程营养管理模式能明显改善头颈恶性肿瘤患者围手术期的营养状况,及早对有营养风险及营养不良（足）的患者进行规范、科学的营养干预,有利于患者康复。

Objective To explore the effect of full nutritional management pattern on perioperative nutritional status in patients with head and neck malignancies. Methods Sixty-four patients with head and neck cancer treated in our department between March 2012 and June 2013 were randomly divided into control group and study group with 32 in each. The control group received conventional dietary guidance, while patients in the study group were given full nutritional management. Nutritional Risk Screening Scale 2002（NRS-2002） was used for nutrition screening and assessment before surgery（after admission） and after surgery（3 days after surgery）. The study group received full nutritional support, along with nutritionrelated physical examination and biochemical tests, and observation of postoperative complications, and hospital stay and costs were also observed. Results Nutritional risk existed in 29.7%-48.4% of the head and neck cancer patients during various stages of the perioperative period. Through the full nutritional support, patients in the study group had a signifi cantly lower risk than those in the control group（P〈 0.01）. Body mass index, triceps skinfold thickness, mid-arm muscle circumference, prealbumin, and creatinine in the study group were signifi cantly more improved compared with the control group（P〈 0.01）. No signifi cant difference was detected in blood urea and serum albumin between the two groups. Postoperative complications in the study group was signifi cantly lower（P〈 0.05）, and hospital stay and costs were signifi cantly lower than the control group（P 〈0.001）. Conclusions Full nutritional management pattern can signifi cantly improve the perioperative nutritional status in head and neck cancer patients. Early detection of nutritional risk and malnutrition（foot） in the patients and carrying out normal and scientifi c nutrition intervention are helpful in the rehabilitation of these patients. We suggest that qualifi ed hospitals should carry out the full nutritional management model managed by a Nutrition Support Team for patients with malignancies.