营养风险及营养支持对老年胃肠道肿瘤患者术后生活质量的影响

Influence of nutritional risk and nutritional support on quality of life after surgery in elderly patients with gastrointestinal tumor

目的调查老年胃肠道肿瘤患者入院时营养风险和住院期间营养支持情况,分析营养风险、营养支持与术后生活质量的关系。方法对老年胃肠道肿瘤患者采用营养风险筛查2002(NRS-2002)、卡氏评分表和癌症患者生活质量量表分别进行术前营养风险评分、卡氏评分和术后3个月生活质量评价,并调查住院期间营养支持情况。结果共有93例患者纳入本研究,术前有营养风险组占52.7%(49/93),无营养风险组占47.3%(44/93)。有营养风险组中进行营养支持比率为71.4%(35/49),无营养风险组中进行营养支持比率为40.9%(18/44)。有营养风险组术前卡氏评分明显低于无营养风险组[(81.23±16.33)分vs.(90.00±8.63)分,P<0.05];有营养风险组术后整体生活质量评分明显低于无营养风险组[(52.79±16.43)分vs.(63.04±16.46)分,P<0.05]。NRS-2002评分分别与术前卡氏评分(r=-0.382,P<0.01)、术后生活质量评分(r=-0.258,P<0.01)呈负相关。其中营养支持可明显改善有营养风险组术后生活质量评分(P<0.05),但不能改善无营养风险组术后生活质量评分(P>0.05)。结论老年胃肠道肿瘤患者术前营养风险发生率较高,且存在营养风险影响卡氏和术后生活质量,对有营养风险的患者进行营养支持可改善术后整体生活质量。

Objective To investigate the nutritional risk on admission and nutritional support during hospitalization in elderly patients with gastrointestinal tumor,and to analyze the correlation between the nutritional risk,nutritional support and quality of life（ QOL） after surgery. Methods Nutritional Risk Screening2002（ NRS-2002）,Karnofsky Performance Status（ KPS） scale and QOL scale of cancer patients were used to assess the nutritional risk score before surgery,KPS score and QOL after 3 months of surgery,respectively.Nutritional support during hospitalization was also investigated. Results In 93 recruited patients,the incidence of nutritional risk（ Risk group） and non nutritional risk（ Non-risk group） was 52. 7%（ 49 /93） and 47. 3%（ 44 /93）,respectively. The rate of nutritional support in Risk group and Non-risk group was 71. 4%（ 35 /49）and 40. 9%（ 18 /44） respectively. Preoperative KPS score in Risk group was significantly lower than that in Non-risk group（ 81. 23 ± 16. 33 vs. 90. 00 ± 8. 63,P〈0. 05）. And postoperative global QOL score in Risk group was also significantly lower than that in Non-risk group（ 52. 79 ± 16. 43 vs. 63. 04 ± 16. 46,P〈0. 05）.NRS-2002 score had a significant negative correlation with preoperative KPS score（ r =- 0. 382,P〈0. 01）and postoperative global QOL score（ r =- 0. 258,P〈0. 01）,respectively. Nutritional support can obviously improve the postoperative global QOL score in Risk group（ P〈0. 05）,but it cannot improve global QOL score in Non-risk group（ P〈0. 05）. Conclusions The incidence of nutritional risk is high in elderly patients with gastrointestinal tumor. And nutritional risk has negative impact on preoperative KPS and postoperative QOL.Nutritional support may improve the postoperative global QOL in elderly gastrointestinal tumor patients with nutritional risk.