术前营养风险筛查对腹腔镜辅助结直肠癌患者术后恢复的影响

Effect of preoperative nutritional risk screening on recovery of patients after laparoscopic-assisted colorectal cancer operation

目的:探讨结直肠癌患者术前营养风险筛查(NRS)对腹腔镜根治手术后恢复的影响,分析导致预后不良的因素。方法:回顾分析2015年1月至2017年8月为120例结直肠癌患者行腹腔镜辅助结直肠癌根治性切除术的临床资料,通过进行NRS 2002营养风险筛查,将患者分为对照组(NRS 2002<3分,不存在营养风险)与观察组(NRS 2002≥3,存在营养风险),比较术前两组患者营养状况,分析术前营养状况对术后并发症及近期疗效的影响。采用单因素、多因素logistic回归分析对术后并发症的危险因素进行分析。结果:两组患者术前BMI、前白蛋白、总胆固醇及淋巴细胞数差异有统计学意义(P<0.05),术后各并发症发生率差异无统计学意义(P>0.05),但总并发症发生率差异有统计学意义(P<0.05);两组腹腔引流量、排气时间、住院费用、病重率及60 d再入院率差异均无统计学意义(P>0.05);观察组术后输血量、输白蛋白量、手术前后体重差、术后住院时间高于对照组,差异均有统计学意义(P<0.05)。单因素与多因素logistic回归分析显示,吸烟、糖尿病及术前存在营养风险是术后发生并发症的独立危险因素。结论:与术前不存在营养风险的患者相比,存在营养风险的患者术后并发症多,近期疗效差。术前应充分纠正患者营养状况,以减少并发症的发生,促进术后患者康复。

Objective:To investigate the effect of preoperative nutrition screening on the recovery of patients with colorectal cancer after laparoscopic radical operation and analyze the adverse prognostic factors.Methods:The clinical data of 120 patients with colorectal cancer who underwent laparoscopic-assisted radical resection from Jan.2015 to Aug.2017 were retrospectively analyzed.All patients were divided into control group(NRS 2002<3,non-nutritional risk)and observation group(NRS 2002≥3,with nutritional risk)through NRS 2002 nutritional risk screening.The nutritional status of patients with different nutritional risks was compared before surgery,and the impact of preoperative nutritional status on postoperative complications and postoperative short-term efficacy was analyzed.Univariate and multivariate logistic regression analysis was used to analyze the risk factors of postoperative complications.Results:There were significant differences in BMI,prealbumin,total cholesterol or lymphocyte count before operation between the two groups(P<0.05),and there was no significant difference in the incidence of postoperative complications(P>0.05),but there was significant difference in the incidence of total complications(P<0.05).There were no significant differences in abdominal drainage volume,exhaust time,hospitalization cost,morbidity or 60-day readmission rate between the two groups(P>0.05).The volume of blood transfusion,the amount of albumin transfusion,the body weight difference before and after surgery,and the hospital stay after surgery in the observation group were more than those in the control group(P<0.05).Univariate and multivariate logistic regression analysis showed that smoking,diabetes mellitus and preoperative nutritional risk were independent risk factors for postoperative complications.Conclusions:Compared with patients without nutritional risk before operation,patients with nutritional risk have more complications and poorer short-term efficacy.The nutritional status should be fully corrected before operation to reduce the incidence of complications and promote the recovery of patients after operation.