术前运用NRS2002评估食管癌患者营养风险及临床结局的研究

Preoperative NRS2002 Assessment of Nutritional Risk of Patients with Esophagus Cancer and Postoperative Results

目的运用营养风险筛查2002（NRS2002）对食管癌术前患者进行营养风险筛查,了解营养风险评分结果和临床结局发生之间的关系。方法运用NRS2002方法对上海交通大学医学院附属仁济医院胸外科于2012年3月至2013年3月收治并手术的225例食管癌患者进行术前NRS2002营养风险筛查,其中男136例、女89例,年龄41~85（64.0±8.2）岁。总评分为疾病严重程度评分、营养状况评分、年龄评分（≥70岁年龄评分为1分,〈70岁为0分）3项的总和。临床结局设定为术后并发症发生率、死亡率和住院时间。结果术前评分≥3分者为75例（33.3%）,〈3分者为150例（66.7%）;NRS2002评分≥3分者术后并发症发生率高于NRS2002评分〈3分者,差异有统计学意义（26.7%vs.12.0%,P〈0.05）;NRS2002评分≥3分者总住院时间长于NRS2002评分〈3者,差异有统计学意义[（29.80±7.94）d vs.（15.30±2.05）d,P〈0.05]。Logistic回归分析结果发现NRS2002、基础疾病、手术方式是术后并发症发生的危险因素。结论术前NRS2002评分≥3分的食管癌患者术后并发症发生率升高,住院时间延长,这提示有必要对于术前营养风险评分≥3分的食管癌患者进行适当及科学的营养干预。NRS2002可以作为评估食管癌术后营养风险发生的预测指标。

Objective To evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002（NRS2002）, and explore the relationship between nutritional risk score and postoperative results. Methods We prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score（age ≥ 70 years old score was 1 point, 〈70 years old for 0 point）. There were 136 males and 89 females with age of 64.0±8.2 years（ranged from 41 to 85 years）. Postoperative results include postoperative complications, mortality, and length of hospital stay. Results The number of patients with preoperative score ≥ 3 points was 75（33.3%）, 〈3 points was 150（66.7%）. The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score ≥ 3 points, and was 12.0% in those with NRS2002 score 〈3 points（P〈0.05）. And the total hospital stay time was longer in the patients with NRS2002 score ≥ 3 points than that with NRS2002 score 〈3 points（29.80±7.94 d vs. 15.30±2.05 d,P〈0.05）. Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. Conclusions Preoperative NRS2002 score ≥ 3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score ≥ 3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.