患者主观整体评估在肝癌肝切除术后并发症中的预测作用

Predictive power of PG-SGA for post-hepatectomy complications in liver cancer patients

目的:评估患者主观整体评估(PG-SGA)对肝癌肝切除术后并发症的预测价值。方法:本研究是一项前瞻性队列研究,共纳入肝癌肝切除病人200例,使用PG-SGA对其进行营养评估。使用Clavien-Dindo分级评估术后并发症发生情况,采用Logistic回归分析确定术后并发症发生的危险因素。结果:根据PG-SGA评估结果,轻中度营养不良发生率43.5%,重度营养不良的发生率为11%。II级及以上并发症发生率是25.5%,其中重度营养不良病人(PG-SGA≥9分)并发症发生率为45.45%。多因素Logistic分析结果显示,手术方式(开腹)[OR=4.00;95%CI:1.28~12.44]、失血量(≥200 mL)(OR=3.68,95%CI:1.83~7.39)和PG-SGA≥9(OR=2.80,95%CI:1.05~7.46)是术后并发症发生的独立风险因素(P<0.05)。结论:术前重度营养不良是术后并发症发生的风险因素,应在术前给与合适的营养治疗和临床防范措施以促进术后恢复。

Objective:The aim of the study was to determine the predictive value of Patient-Generated Subjective Global Assessment(PG-SGA)for complications after hepatectomy in patients with liver cancer.Methods:A total of 200 patients with liver cancer who underwent hepatectomy were enrolled.Nutritional evaluation was performed using PG-SGA.Clinical data and details of surgery were retrospectively analyzed.Logistic regression analysis was used to determine the risk factors for postoperative complications.Results:According to the PG-SGA,the incidence of mild to moderate malnutrition was 43.5%,and the severe malnutrition was 11%.The incidence of Grade II and above postoperative complications was 25.5%in the overall and the complication rate of severely malnourished patients(PGSGA≥9 points)was 45.45%.The results of multivariate Logistic analysis showed that laparotomy[OR=4;95%CI:1.28~12.44],blood loss(≥200 mL)(OR=3.68,95%CI:1.83~7.39)and PG-SGA≥9(OR=2.80,95%CI:1.05~7.46)were independent risk factors for postoperative complications in patient with liver cancer.Conclusion:Severe malnutrition was found to be a risk factor for postoperative complications.Appropriate nutritional treatment and clinical precautions should be given before surgery to promote postoperative recovery.