口服营养补充在肝癌肝切除患者术后加速康复中的应用

Application of oral nutrition supplement in enhanced recovery of patients with liver cancer undergoing hepatectomy

目的探讨口服营养补充(ONS)在原发性肝癌(肝癌)肝切除患者术后加速康复中的应用价值。方法本前瞻性研究对象为2016年11月至2018年2月在中国科学技术大学附属第一医院诊治的70例肝癌肝切除患者。其中男52例,女18例;年龄28~76岁,中位年龄59岁。患者均签署知情同意书,符合医学伦理学规定。按照随机数字表法将患者分为营养组和对照组,每组各35例。对照组给予常规饮食指导和静脉营养,营养组在对照组基础上再给予ONS营养支持治疗。比较两组患者体重、握力及实验室营养指标变化、输注人血白蛋白总量、低蛋白血症持续时间、术后情况等。结果术后两组患者营养风险筛查量表2002评分均在3分以上,100%存在营养风险。营养组患者术后7 d较入院时体重减轻1.0(0~6.0)kg,明显低于对照组的2.5(0~7.0)kg(Z=-2.607,P<0.05)。术后7 d营养组患者握力为(33±3)kg,明显高于对照组的(30±4)kg(t=3.210,P<0.05)。营养组术后7 d前白蛋白、血清白蛋白分别为(139±40)mg/L、(39±5)g/L,明显高于对照组的(120±41)mg/L、(37±3)g/L(t=2.012,2.254;P<0.05)。营养组术后住院时间、术后排便时间分别为(8.1±2.6)d、(67±28)h,明显短于对照组的(10.1±5.4)d、(87±37)h(t=-2.010,-2.550;P<0.05)。结论ONS可改善肝癌患者术后营养状态,促进患者肠道功能恢复,缩短住院时间,加快术后康复。

Objective To explore the application value of oral nutrition supplement(ONS)in the enhanced recovery of patients with primary liver cancer(PLC)after hepatectomy.Methods A total of 70 patients with PLC undergoing hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from November 2016 to February 2018 were enrolled in this prospective study.Among them,52 patients were male and 18 female,aged 28-76 years with a median age of 59 years.The informed consents of all patients were obtained and the local ethical committee approval was received.Patients were divided into the ONS(n=35)and control groups(n=35)according to the random number table method.In the control group,routine dietary instruction and intravenous nutrition were given,whereas ONS was added in the ONS group.The changes of body weight,grip strength,nutrition index,total amount of infused human albumin,duration of hypoproteinemia,and postoperative condition were statistically compared between two groups.Results The postoperative scores of Nutrition Risk Screening Scale 2002 were above 3 in two groups,indicating that 100%of the patients had nutrition risk.In the ONS group,the body weight of patients was reduced by 1.0(0-6.0)kg at postoperative 7 d,significantly lower compared with 2.5(0-7.0)kg in the control group(Z=-2.607,P<0.05).The grip strength at postoperative 7 d in the nutrition group was(33±3)kg,significantly larger than(30±4)kg in the control group(t=3.210,P<0.05).In the ONS group,the serum levels of prealbumin and albumin were(139±40)mg/L and(39±5)g/L,significantly higher than(120±41)mg/L and(37±3)g/L in the control group(t=2.012,2.254;P<0.05).The postoperative length of hospital stay and defecation time in the ONS group were(8.1±2.6)d and(67±28)h,significantly shorter than(10.1±5.4)d and(87±37)h in the control group(t=-2.010,-2.550;P<0.05).Conclusions ONS can improve the postoperative nutritional status,promote the recovery of intestinal function,shorten the length of hospital stay and accelerate postoperative recovery of PLC patients.