胃肠外科患者营养风险筛查及围手术期营养支持对胃癌患者恢复影响的临床研究

Nutritional risk screening among patients in department of gastrointestinal surgery and effectiveness of perioperative nutrition support on recovery of gastric cancer patients

目的研究胃肠外科住院患者的营养风险状况及其相关影响因素,并研究营养支持对胃癌患者术后恢复的影响。方法前瞻性收集2015年1月至2016年1月期间于山东大学附属济南市中心医院胃肠外科住院的患者1 048例。采用营养风险筛查2002(NRS-2002)量表对这些患者进行营养风险筛查,并于患者出院时评估其实际营养不良发生情况。再收集NRS评分≥3分的胃癌患者52例,随机分为试验组26例和对照组26例。试验组患者给予标准的营养支持治疗,对照组患者不给予规范的营养支持。比较2组患者的术后营养指标,以及术后首次排气时间、首次排便时间、停止静脉输液时间、住院时间、并发症发生率等术后恢复指标。结果 (1)营养风险。1 048例胃肠外科住院患者中,存在营养风险230例,营养风险的发生率为21.9%;发生营养不良118例,营养不良的发生率为11.3%。营养风险与年龄和肿瘤分期均有关(P<0.05),与性别无关(P>0.05)。≥60岁、进展期胃癌、Ⅲ期+Ⅳ期结直肠癌患者的营养风险发生率相应高于<60岁、早期胃癌、Ⅰ期+Ⅱ期结直肠癌患者。营养风险筛查结果和实际营养不良结局间有较好的一致性(κ=0.57)。(2)营养支持对胃癌患者的影响。对照组和试验组患者手术前后体质量、前白蛋白和白蛋白水平的差值比较差异均有统计学意义(P<0.05),试验组患者的体质量、前白蛋白和白蛋白水平在术后升高更为明显。此外,试验组和对照组患者的首次排气时间和并发症发生率比较差异均无统计学意义(P>0.05),但2组患者的首次排便时间、停止静脉输液时间及住院时间比较差异均有统计学意义(P<0.05),试验组的首次排便时间、停止静脉输液时间及住院时间均较对照组短。结论营养不良问题在胃肠外科住院患者中是普遍存在的。应用有效的营养风险评估工具,对风险较早作出评估,并积极给予适当的营养支持治疗,会对胃癌患者的预后带来有利影响。

Objective To explore the status of nutrition risk and its relative factors in patients of department of gastrointestinal surgery, and to observe the effectiveness of nutrition support on post-operative recovery of patients with gastric cancer. Methods A total of 1 048 cases of in-patients in Department of Gastrointestinal Surgery of Jinan Central Hospital Affiliated Shandong University from January 2015 to January 2016 were collected prospectively, and then screened the nutrition risk of these patients by nutritional risk screening 2002 （NRS-2002） and evaluated the actual malnutrition situation when they left hospital. Then collected 52 gastric cancer patients whose NRS-2002 score ≥3, and divided them to control group and experimental group randomly. The patients of experimental group received extra standard medical nutrition support while the patients of control group did not. Compared the nutritional indexes as well as some postoperative recovery indexes, such as the postoperative exhaust time, postoperative defecation time, infusion stop time, length of hospital stay, and incidence of complications. Results ① Nutritional risk. Among the 1 048 cases, 230 cases （21.9%） had nutritional risk while 118 cases （11.3%） developed to malnutrition. Age and degree of cancer were all related with nutritional risk （P〈0.05） while gender was irrelevant （P〉0.05）. Patients with age ≥60 years, advanced gastric cancer, and colorectal cancer in Ⅲ＋Ⅳ staging, had higher rates of nutritional risk than patients with age 〈60 years, early gastric cancer, and colorectal cancer inⅠ＋Ⅱstaging. Results of actual malnutrition was in good accordance with the screening result of NRS-2002 （κ=0.57）. ② Influence of nutritional support on gastric cancer patients. Compared with control group, there was an improvement in albumin, pre-albumin, and weight of experimental group and the distinction had statistical significance （P〈0.05）. The distinction of postoperative exhaust time and incidence of complication between the two groups were not statistically significant （P〉0.05）, but postoperative defecation time, infusion stop time, and the length of hospital stay of the experimental group were shorter than those of the control group with statistical significance （P〈0.05）. Conclusions The problem of malnutrition exists generally in the in-patients of department of gastrointestinal surgery. Applying the instrument of nutritional risk assessment to assess the risk as early as possible and giving appropriate nutrition support therapy positively, will make favorable influence to the prognosis of gastric cancer patients.