胃癌围手术期营养风险和并发症影响因素分析

Risk factors of perioperational nutritional risk and complications of radical gastrectomy for gastric cancer

目的胃癌是最常见的消化道恶性肿瘤,围手术期营养风险和并发症发生率较高,本研究旨在分析胃癌患者围手术期营养风险和并发症的影响因素。方法收集2011-11-01-2014-11-01山东大学附属山东省肿瘤医院胃肠外科876例胃癌手术患者的营养风险、营养支持和围手术期并发症等数据,分析营养风险以及并发症的相关因素,进一步分析营养支持和并发症的关系。结果(1)有营养风险492例,发生率为56.2%,其中积分3分占27.1%,4~7分占29.1%。单因素分析结果显示,年龄、临床分期、病理鲍曼分型和并发症与营养风险相关;多因素分析显示,年龄>65岁、病理Ⅲ期和并发症是独立危险因素。(2)有并发症158例,发生率为18.0%。单因素分析显示,年龄、病理分期、鲍曼分型、术中出血量、ASA评分、营养风险和并发症与并发症显著相关;多因素分析显示,年龄>65岁、病理分期Ⅲ期、营养风险、ASA评分和并发症是独立危险因素。(3)分层分析显示,有风险者营养支持并发症为17.9%,低于无规范营养支持的29.2%,无营养风险者营养支持对并发症无显著性影响。结论影响胃癌营养风险和并发症的独立危险因素有年龄、病理分期和并发症,营养风险为并发症的独立危险因素,规范的营养支持为营养风险者并发症的保护性因素。

OBJECTIVE We aimed to study the risk factors of nutrition risk and complications in gastrectomy of gastric cancer in Shandong Cancer Hospital Affiliated to Shandong University. METHODS A total of 876 patients with gastric cancer undergoing gastrectomy from November 2011 to November 2014 were inclued in the study of risk factors of nutritional risk and complications analysis. The relationship of nutritional support and complications were investigated. RESULTS （1）The nutrition risk occurred in 492（56.2%） of 876 patients. According to the single factors analysis age, clinical stage, Borrmann type and comorbidity were related to nutritional risk. By logistic regression analysis, it was re- vealed that ages old more than 65,clinical Ⅲ stage, comorbidity and Borrmann IV type were significant factors. （2） Complication rates was 18. 0%. According to the single factors analysis age, clinical stage, Borrmann type, comorbidity, blood loss, ASA score and nutritional risk were related to complications. By logistic regression analysis, it was revealed that old more than 65 years, clinical Ⅲ stage, comorbidity, ASA score and nutritional risk were significant factors. （3） Stratified analysis showed that patients with nutritional risk who underwent nutritional support had a significant less complication rate of 17.9% than those without nutritional support of 29.2%. CONCLUSIONS Age, clinical stage and comorbidity were the main risk factors of nutritional risk and complications of gastric cancer. Nutritional risk was main risk factor of complications. Standard nutritional support was protective factor of patients with nutritional risk.