ERAS在胃癌根治术患者中的应用效果及PG-SGA、NRS2002评估分析

Application effect of ERAS in patients with radical gastrectomy for gastric cancer and evaluation and analysis of PG-SGA and NRS2002

目的从胃癌根治术后肛门首次排气时间方面观察住院胃癌患者应用加速康复外科(ERAS)的价值,并分析营养风险筛查2002(NRS2002)及整体营养状况主观评估(PG-SGA)的评估效果。方法 216例行胃癌根治术患者,根据患者意愿分为ERAS组(148例)与传统组(68例)。所有患者入院48 h内应用NRS2002及PG-SGA进行营养评估;ERAS组患者围术期采用ERAS处理方案,传统组患者围术期采用传统处理方案。观察患者术前营养风险、营养不良情况,以及两组不同NRS2002评分及不同PG-SGA评分级别患者术后肛门首次排气时间。结果 216例患者中,术前无营养风险102例,有营养风险114例。216例患者术前营养不良A级24例、B级140例、C级52例。ERAS组NRS2002评分<3分、NRS2002评分≥3分患者肛门排气时间分别为(43.79±12.36)、(43.74±14.00)h,明显短于传统组的(93.95±20.95)、(76.00±22.97)h,差异具有统计学意义(P<0.05)。ERAS组患者PG-SGA评分A、B、C级术后肛门首次排气时间分别为(41.75±13.79)、(44.28±13.61)、(43.25±12.86)h,短于传统组的(94.00±18.29)、(81.58±24.37)、(79.07±23.65)h,差异具有统计学意义(P<0.05);ERAS组PG-SGA评分A、B、C级患者间术后肛门首次排气时间比较差异无统计学意义(P>0.05)。结论术前对胃癌患者进行NRS2002及PG-SGA评估有助于客观评价患者的营养状态;对不同营养状态的胃癌患者,ERAS措施相较传统方案均能明显缩短胃癌根治术后肛门首次排气时间。

Objective To observe the value of enhanced recovery after surgery（ERAS） in inpatients with gastric cancer from the time of first anus exhaust after radical gastreetomy for gastric cancer, and analyze the evaluation effect Of nutritional risk screening 2002 （NRS2002） and patient-generated subjective global assessment （PG-SGA）. Methods A total of 216 patients with radical gastreetomy for gastric cancer were divided by patients＇ willing into ERAS group （148 cases） and traditional group （68 cases）. All patients received NRS2002 and PG- SGA for nutritional assessment within 48 h of hospital admission. ERAS group received ERAS processing regimen during the perioperative period, and the traditional group received conventional processing regimen during the perioperative period. Observation were made on preoperative nutritional risk, malnutrition, and first anal exhaust time after operation in patients with different NRS2002 scores and different PG-SGA grades. Results Among 216 patients, there was 102 eases without nutritional risk before surgery and 114 cases with nutritional risk. In 216 patients, there were 24 cases of grade A malnutrition before operation, 140 cases of grade B and 52 eases of grade,C. The ERAS group had obviously shorter anal exhaust time in patients with NRS2002 scores 〈3 points and NRS2002 scores 〉±3 points as （43.79 ± 12.36） and （43.74 ± 14.00） h than （93.95 ± 20.95） and （76.00 ± 22.97）h in traditional group, and the difference was statistically significant （P〈0.05）. ERAS group had obviously shorter first anal exhaust time after operation in patients with the grade A, B, C of PG-SGA score as （41.75 ± 13.79）, （44.28 ± 13.61） and （43.25 ± 12.86）h than （94.00 ± 18.29）, （81.58 ± 24.37） and （79.07 ± 23.65）h in traditional group, and the difference was statistically significant （P〈0.05）. There was no statistically significant difference of first anal exhaust time after operation in patients with grade A, B and C of PG-SGA score in ERAS group （P〉0.05）. Conclusion Preoperative assessment of gastric cancer patients with NRS2002 and PG-SGA helps to objectively evaluate the patient＇ s nutritional status. For patients with different nutritional status of gastric cancer, ERAS measures can significantly shorten first anal exhaust time after radical gastrectomy for gastric cancer comparing with traditional regimen.