个体化营养治疗对消化系统疾病围手术期患者临床结局的影响

Effect of individualized nutritional therapy on clinical outcome of perioperative patients with digestive system diseases

目的探讨个体化营养治疗对存在营养风险的消化系统疾病围手术期患者临床结局的影响。方法采用前瞻性、随机对照临床试验研究方案将纳入研究的217例消化系统疾病择期手术患者随机分为研究组(112例,行个体化营养治疗)和对照组(105例,行非个体化营养治疗),记录并比较两组患者基线资料,及术后并发症、住院时间、住院费用、病死率和生活质量改善情况。结果两组患者的性别、年龄、文化程度、居住地、医疗费用支付方式和营养风险筛查(NRS)2002评分差异均无统计学意义(P均>0.05)。研究组术后感染性并发症发生率低于对照组[8.0%(9/112)vs 17.1%(18/105),P=0.042],而研究组和对照组的总并发症、非感染性并发症发生率的差异均无统计学意义[15.2%(17/112)vs 22.9%(24/105)、7.1%(8/112)vs 5.7%(6/105),P均>0.05];研究组总住院时间、术后住院时间和总住院费用均低于对照组(P均<0.05);两组术后病死率差异无统计学意义(P=0.286)。多因素logistic回归分析显示,性别、NRS 2002评分和营养方式是术后发生感染性并发症的影响因素(P均<0.05)。多元逐步回归分析显示,手术类型、NRS 2002评分和营养方式是总住院时间的影响因素(P均<0.01),年龄、营养方式和感染性并发症是术后住院时间的影响因素(P均<0.05);手术类型、营养费用和总住院时间是总住院费用的影响因素(P均<0.05);营养方式和总住院时间是营养费用的影响因素(P均<0.01)。两组出院前欧洲癌症研究与治疗组织(EORTC)生命质量核心问卷(QLQ-C30)评分[(58.9±17.1)分vs(56.3±18.5)分]差异无统计学意义(P=0.631),但研究组躯体功能、情绪功能、疲乏症状评分和经济困难评分均优于对照组(P均<0.05),恶心呕吐症状评分劣于对照组(P<0.05)。结论消化系统疾病患者围手术期实施个体化营养治疗有利于降低术后感染性并发症发生率、缩短住院时间、减少住院费用,改善患者生活质量。

Objective To investigate the effect of individualized nutritional therapy on the clinical outcome of perioperative patients with nutritional risks in digestive system diseases.Methods A prospective,randomized controlled clinical trial was conducted in 217 patients with digestive system diseases undergoing elective surgery,including 112 patients in the study group(receiving individualized nutritional therapy)and 105 patients in the control group(receiving nonindividualized nutritional therapy).The baseline data,postoperative complications,hospital stay,hospital costs,postoperative mortality and improvement of the quality of life were recorded and compared.Results There were no differences in gender,age,education level,place of residence,payment method of medical expenses or nutritional risk screening(NRS)2002 score between the two groups(all P>0.05).The incidence of postoperative infectious complications in the study group was lower than that in the control group(8.0%[9/112]vs 17.1%[18/105],P=0.042),while there were no differences in the incidence of total complications or non-infectious complications between the study group and the control group(15.2%[17/112]vs 22.9%[24/105],7.1%[8/112]vs 5.7%[6/105],both P>0.05).The total hospital stay,postoperative hospital stay and total hospital costs of the study group were all lower than those of the control group(all P<0.05).There was no difference in postoperative mortality between the two groups(P=0.286).Multivariate logistic regression analysis showed that gender,NRS 2002 score and nutritional mode were the influencing factors of postoperative infectious complications(all P<0.05).Multiple stepwise regression analysis showed that the surgery type,NRS 2002 score and nutritional mode were the influencing factors of total hospital stay(all P<0.01),and age,nutritional mode and infectious complications were the influencing factors of postoperative hospital stay(all P<0.05).Surgical type,nutritional costs and total hospital stay were the influencing factors of total hospital costs(all P<0.05).Nutritional mode and total hospital stay were the influencing factors of nutritional costs(both P<0.01).There was no significant difference in European Organization for Research and Treatment of Cancer(EORTC)quality of life questionnaire-core 30(QLQ-C30)scores between the two groups before discharge(58.9±17.1 vs 56.3±18.5)(P=0.631),but the scores of physical function,emotional function,fatigue and financial difficulty in the study group were all better than those in the control group(all P<0.05),and the score of nausea and vomiting was worse than that in the control group(P<0.05).Conclusion Individualized nutritional therapy can decrease the incidence of postoperative infectious complications,shorten the length of hospital stay,reduce the hospital costs,and improve the quality of life of perioperative patients with digestive system diseases.