不同营养筛查方法对胃癌胃切除患者适用性的对比

Comparison of Applicability for Different Nutritional Screening Methods in Gastric Cancer Patients Undergoing Gastrectomy

目的:结合人体成分分析等营养指标,比较NR S2002和PG-SGA在胃癌患者术前营养评估的临床价值,筛选出适合于胃癌胃切除患者的营养评估方法。方法:分别使用NRS 2002和PG-SGA对91例胃癌胃切除患者进行术前营养风险筛查,比较其结果的一致性,以及与人体成分分析结果和传统营养指标的相关性。结果:NRS 2002与PG-SGA的营养风险筛出率分别为42.9%、71.4%,两者一致性检验Kappa=0.188(P<0.05),提示两种筛查方法的一致性较差。术前白蛋白、身体水分、肌肉量、去脂体重、骨骼肌、上臂周长、上臂无脂周长、浮肿、基础代谢率等营养指标在不同营养风险患者中差异有统计学意义(P<0.05);总住院天数、术后住院天数以及术后并发症在不同营养风险患者中差异无统计学意义(P>0.05)。结论:人体成分分析联合应用NRS 2002、PG-SGA在预测评价胃癌胃切除患者术前营养状况时有一定的意义,PG-SGA营养风险筛出率高于NRS 2002。倘单独使用任何一种营养筛查方法都存在不同的缺陷,在临床中应该同时应用,相互补充。

Objective:To compare the clinical value of NRS 2002 and PG-SGA in preoperative nutritional assessment of gastric cancer patients by combining human body composition analysis and other nutritional indicators.Methods:NRS 2002 and PG-SGA were applied to 91 patients with gastric cancer for preoperative nutritional risk screening,to compare their consistency in results and correlation with body composition analysis and traditional nutritional indicators.Results:The rate of patients at nutritional risk was 42.9%screened out by NRS 2002,and 71.4%by PG-SGA.The result of consistency test,Kappa=0.188(P<0.05),indicated that the consistency of the two screening methods was poor.Differences of preoperative albumin,body water,muscle mass,fat-free body weight,skeletal muscle,upper arm circumference,upper arm fat-free perimeter,edema,basal metabolic rate and other nutritional indicators were statistically significant in patients with different nutritional risks(P<0.05);while those of total hospitalization days,postoperative hospital stay days and postoperative complications were not statistically significant(P>0.05).Conclusion:The combination of human body composition analysis with NPS 2002 and PG-SGA has certain merits in predicting the preoperative nutritional status of gastric cancer patients with gastric resection.The rate of nutritional risk screened out by PG-SGA is higher than that by NRS 2002.However,the use of any of the nutritional screening methods alone is insufficient.The two screening methods should be applied simultaneously and complemented each other in clinical practice.