开放性胃癌根治术围术期营养支持治疗现状调查

A survey of perioperative nutritional support for open radical gastric cancer surgery

目的:分析开放性胃癌根治术围术期营养支持治疗的现状及可能存在的不足,为进一步改善围术期营养支持治疗提供依据。方法:回顾性分析复旦大学附属中山医院2019年1月至12月择(限)期完成开放性胃癌根治术的1304例患者的临床资料,比较围术期营养支持比例、途径及成分、相关指标水平等。结果:仅接受术前营养支持者、仅接受术后营养支持者、术前术后均接受营养支持者分别占1.7%、56.9%、8.6%,共占67.2%(876/1304)。术前采用完全肠外营养支持(total parenteral nutrition,TPN)与肠内营养支持(enteral nutrition,EN)者分别为112、21例(5.3∶1),术后采用TPN、EN、PN+EN者分别为558、102、194例(5.5∶1∶1.9)。术后进行TPN的558例患者中,采用全合一(all in one,AIO)营养液者107例,其总热量、每千克体质量热量、每千克体质量蛋白质补充量、热氮比分别为(1256.7±169.4)kcal/d、(20.7±4.0)kcal·kg^(-1)·d^(-1)、(1.2±0.5)g·kg^(-1)·d^(-1)、(101.1±53.8)∶1;采用单瓶营养素者451例,总热量、每千克体质量热量、每千克体质量蛋白质补充量、热氮比分别为(325.2±79.2)kcal/d、(5.4±1.7)kcal·kg^(-1)·d^(-1)、(0.4±0.1)g·kg^(-1)·d^(-1)、(58.0±23.7)∶1。术后仅采用AIO进行TPN者术前白蛋白[(39.7±5.0)g/L]、前白蛋白[(211.2±55.6)mg/L]显著低于仅采用单瓶营养素支持者[(41.3±4.0)g/L、(222.4±52.0)mg/L,P<0.05],术后血糖[(6.3±2.0)mmol/L]高于采用单瓶营养素支持者[(5.5±1.3)mmol/L,P<0.01]。结论:营养支持已得到重视,围术期营养支持较高,但术后TPN中蛋白质/氨基酸供给量未达到指南要求。

Objective:To analyze the current status and possible deficiencies of perioperative nutritional support treatment for patients undergoing open radical gastric cancer surgery,in order to improve the perioperative nutritional support treatment.Methods:A total of 1304 patients who completed open radical gastric cancer surgery in Zhongshan Hospital,Fudan University from January to December 2019 were included,the clinical data of all patients were analyzed retrospectively.The perioperative nutritional support ratio,approach,and composition,as well as relevant laboratory parameters were analyzed.Results:The patients received preoperative nutritional support only,postoperative nutritional support only,and preoperative plus postoperative nutritional support accounted for 1.7%,56.9%,and 8.6%,respectively.67.2%(876/1304)patients were given nutritional supports during the perioperative time.Before surgery,the total parenteral nutrition(TPN)and enteral nutrition(EN)were used in 112,21 patients,respectively,and the ratio was 5.3∶1.After the operation,TPN,EN,and PN+EN were used in 558,102,and 194 patients,respectively,and the ratio was 5.5∶1∶1.9.Among patients who used TPN after surgery,107 patients used all in one(AIO)nutrients and total calories,calories/kg,protein/kg,and heat-nitrogen ratio were(1256.7±169.4)kcal/d,(20.7±4.0)kcal·kg^(-1)·d^(-1),(1.2±0.5)g·kg^(-1)·d^(-1),and(101.1±53.8)∶1 in these patients,respectively;451 patients used single bottle of nutrients,and total calories,calories/kg,protein/kg,and heat-nitrogen ratio were(325.2±79.2)kcal/d,(5.4±1.7)kcal·kg^(-1)·d^(-1),(0.4±0.1)g·kg^(-1)·d^(-1),and(58.0±23.7)∶1.The preoperative levels of albumin and prealbumin of the patients receiving AIO were(39.7±5.0)g/L and(211.2±55.6)mg/L,and were significantly lower than those of patients receiving single bottle nutrient support([41.3±4.0]g/L,[222.4±52.0]mg/L;P<0.05),and the postoperative level of blood glucose was(6.3±2.0)mmol/L and was significantly higher than that of patients receiving single bottle of nutrients(5.5±1.3)mmol/L(P<0.01).Conclusions:Nutritional support has been gradually improved,the proportion of perioperative nutritional support is higher,but protein/amino acid supplied by postoperative TPN does not meet the clinical requirements.