肺癌手术患者营养风险调查及对临床结局的影响

Investigation on nutritional risk of patients with lung cancer surgery and its effect on clinical outcomes

目的了解肺癌手术患者营养状况,对营养风险相关因素进行分析并评估营养风险对临床结局的影响。方法收集同济大学附属上海市肺科医院2014年1月至2017年12月收治的肺癌手术患者,采用营养风险筛查2002(NRS 2002)评估肺癌手术患者营养风险和营养不良发生率,并记录患者一般资料和营养相关指标实验室检查结果。结果本研究共收集到符合纳入、排除标准肺癌手术患者640例。营养风险发生率为41.6%,其中女性发生率高于男性(χ^2=6.80,P<0.05);年龄65岁以上的患者发生率高于65岁以下患者(χ^2=35.96,P<0.001);不同手术方式肺癌患者营养风险发生率不同,且存在统计学差异(χ^2=17.96,P<0.001);营养风险发生率在不同等级手术患者之间存在着显著的差异(χ2=6.61,P<0.05),且发生率随手术等级的增大而升高;肺癌手术患者营养风险发生率在体质指数(BMI)低于正常值范围组(<18.5kg/m^ 2)、正常值范围组(18.5~23.9kg/m 2)和高于正常值范围组(≥24kg/m^ 2)之间存在显著的差异(χ^2=168.80,P<0.001),且随BMI值升高其营养风险发生率下降。而营养风险发生率在不同病理类型肺癌患者间差异无统计学意义(χ^2=0.19,P>0.05)。有营养风险的患者术后引流量(t=2.42,P<0.05)、住院时间(t=2.48,P<0.05)及住院费用(t=2.45,P<0.05)明显高于营养状况正常的患者,差异均有统计学意义。结论肺癌手术患者营养风险发生率较高,且与性别、年龄、手术方式和等级、BMI有关。且营养风险发生可导致患者术后引流量增加,住院时间延长,住院费用增加。因此,对肺癌手术患者进行营养风险筛查并及时进行干预,改善患者临床结局。

Objective The aim of this paper was to evaluate the nutritional status of patients undergoing lung cancer surgery in Shanghai Pulmonary Hospital,Tongji University and analyze the related factors of nutritional risk and assess the impact of nutritional risk on clinical outcomes,to provide a scientific reference for nutrition interventions of patients with lung cancer surgery.Methods Collect data of patients undergoing lung cancer surgery in Shanghai Pulmonary Hospital,Tongji University from January 2014 to December 2017.The nutritional risk and malnutrition rate of lung cancer surgery patients was assessed by the nutritional risk screening 2002(NRS 2002)and general information and nutrition relevant indicators results of the patients were recorded.Results Data of 640 patients with lung cancer surgery who met the inclusion and exclusion criteria were collected in this study.The incidence of nutritional risk was 41.6%,of which the incidence was higher in women than in men(χ^2=6.80,P<0.05);The incidence of patients whose age over 65 years was higher than those of patients under 65 years(χ^2=35.96,P<0.001);The incidence of nutritional risk was statistically different among lung cancer patients with different surgical methods(χ^2=17.96,P<0.001);There were significant differences in the incidence of nutritional risk among patients with different grades of surgery(χ^2=6.61,P<0.05)and the incidence increased with the grade of surgery.In addition,the incidence of nutritional risk in patients with lung cancer surgery was significantly different between the body mass index(BMI)below the normal range,the BMI in normal range(18.5-23.9kg/m ^2),and the BMI above the normal range(χ^2=168.80,P<0.001)and the incidence of nutritional risk decreases as the BMI value increase.There was no significant difference in the incidence of nutritional risk among patients with different pathological types of lung cancer(χ^2=0.19,P>0.05).At the same time,we also found that patients with nutritional risk had a higher postoperative drainage volume(t=2.42,P<0.05),a longer hospital length of stay(t=2.48,P<0.05),and a higher hospitalization costs(t=2.45,P<0.05)than patients with normal nutrition and the differences were all statistically significant.Conclusion Nutritional risk is common in patients with lung cancer surgery and is associated with gender,age,surgical method and grade,and BMI.And the occurrence of nutritional risk can increase postoperative drainage volume,prolong hospital stay,and increase hospitalization costs.Therefore,nutritional risk screening and timely intervention for lung cancer surgery patients can improve their clinical outcomes.