集束化干预策略在胃癌围手术期营养支持中的应用

Application of intervention bundles in perioperative nutrition support of patients with gastric cancer

目的探讨集束化干预策略在胃癌患者围手术期营养支持中的临床价值。方法收集2016年6月-2018年5月在南京医科大学附属淮安第一医院行胃癌根治术的患者200例,其中2017年6月-2018年5月共100例胃癌患者围手术期采用集束化干预策略进行营养干预(研究组);2016年6月-2017年5月共100例胃癌患者围手术期按常规营养支持处理(对照组)。结果 2组患者术前营养评估及实验室指标的营养状况对比差异无统计学意义(P> 0.05);研究组患者术后第7天营养评分、白蛋白及前白蛋白指标明显优于对照组,差异有统计学意义(P <0.05);研究组并发症的发生率明显低于对照组(χ2=4.348,P=0.037);与对照组相比,研究组术后肛门首次通气时间、术后首次排便时间、术后住院时间均显著缩短,住院总费用明显减少,差异均有统计学意义(P <.05)。结论胃癌患者围手术期的快速康复依赖于充分的营养支持。集束化营养干预策略的运用可有效改善胃癌患者术后的营养状态、减少并发症发生和改善患者临床结局。

Objective To investigate the value of bundles of intervention in perioperative nutrition support of patients with gastric cancer. Methods From June 2016 to May 2018, 200 patients in Department of Thoracic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University with gastric cancer were collected. From June 2017 to May 2018, 100 patients were treated with bundles of intervention during perioperative period(study group), and from June 2016 to May 2017, 100 cases were given routine nutritional support(control group). Results There was no significant difference in preoperative nutrition assessment and laboratory indicators related to nutritional status between two groups(P > 0.05). The nutrition score,level of albumin and prealbumin was remarkably higher in the study group than in the control group on postoperative day 7(P < 0.05). The incidence rate of complications of the study group was significantly lower than the control group(χ~2= 4.348, P = 0.037). Compared with the control group, the times of first flatus and first defecation, length of hospital stay and total expenses were significantly lower in the study group(P <0.05). Conclusion The rapid recovery of patients with gastric cancer in the perioperative period relies on sufficient nutritional support. The application of bundles of intervention can significantly improve the postoperative nutrition status, decrease the incidence of complications and ameliorate clinical outcome of patients with gastric cancer.