术前营养风险筛查在评估前列腺癌根治术快速康复方案可行性中的作用

The role of preoperative nutritional risk screening in assessing the feasibility of the enhanced early recovery after radical prostatectomy

目的:探讨术前营养风险筛查评估前列腺癌根治术围手术期快速康复可行性的作用。方法:我们进行了一个回顾性队列研究,纳入2013年10月至2018年12月于宜兴市人民医院行前列腺癌根治术的224名患者,所有患者均由同一团队行前列腺癌根治术。我们分别采用NRS-2002评分和PG-SGA评分对所有患者进行术前营养风险筛查,2016年12月起我院采取快速康复外科(enhanced recovery after surgery,ERAS)策略,比较营养风险组和营养正常组术后住院天数、导尿管留置时间、引流管留置时间、首次排便时间、独立活动时间以及术后并发症发生情况等,以及不同营养风险患者在ERAS和常规方案中的住院天数、导尿管留置时间、术后并发症发生情况等的差异。结果:营养风险组和营养正常组患者在年龄、手术时间、术中出血量、术后Gleason评分等方面均无统计学差异,营养状况与BMI具有相关性。根据NRS-2002和PG-SGA量表,营养正常患者中,ERAS组较常规组住院天数、导尿管留置时间、引流管留置时间、首次排便时间以及独立活动时间都有明显改善,差异有统计学意义;而在营养风险患者中,ERAS组较常规组住院天数和首次排便时间都明显延长,差异有统计学意义。结论:术前进行营养评估有助于筛选营养风险患者,避免不必要的术后恢复风险,选择合适的ERAS患者,值得在泌尿外科临床工作中推广应用。

Objective:To investigate the role of preoperative nutritional screening in assessing the feasibility of the enhanced early recovery after radical prostatectomy.Methods:We conducted a retrospective cohort study enrolled 224 patients who underwent prostatectomy at People’s Hospital of Yixing City from October 2013 to December 2018.We used NRS-2002 score and PG-SGA score to screen preoperative nutritional risk for all patients with prostatectomy.From December 2016,we pursued the enhanced recovery after surgery(ERAS) strategy.Several postoperative early recovery items were compared between patients with different nutritional risks such as urinary catheter indwelling time,postoperative complications,hospitalization days,drainage tube retention time,first defecation time,and independent activity time as well as patients with ERAS or conventional care regimens.Results:There were no significant differences in age,duration of surgery,intraoperative blood loss,and postoperative Gleason score between the nutritional risk group and the normal nutrition group.The nutritional status was correlated with BMI.According to the NRS-2002 and PG-SGA scores,in the normal nutrition patients,the ERAS group had significantly improved hospitalization days,catheter indwelling time,drainage tube indwelling time,first defecation time,and independent activity time compared with the conventional nursing group.In the nutritional risk patients,the ERAS group obtained a statistically longer hospitalization days and first defecation time when compared with the conventional nursing group.Conclusion:Preoperative nutritional assessment can help to screen patients with nutritional risk,thereby avoiding unnecessary risk of postoperative recovery,and choosing the suitable ERAS patients,which is worthy of promotion and application in routine urology clinical practice.