肝癌患者围手术期营养风险和营养支持状况的研究

Study on nutritional risk and nutritional support in patients with liver cancer during perioperative period

目的探讨肝癌患者围手术期营养风险和营养支持情况。方法回顾性分析2019年1月至2020年1月中国医学科学院北京协和医学院肿瘤医院收治的507例肝癌手术患者的临床资料。应用营养风险筛查2002(NRS 2002)进行评估,≥3分为有营养风险,并统计营养支持情况。结果507例患者中有营养风险82例(16.2%)。男性和女性有营养风险率比较差异无统计学意义[15.3%(58/379)比18.8%(24/128),χ^(2)=0.838,P=0.405];原发性肝癌患者和继发性肝癌患者有营养风险率比较差异无统计学意义[18.0%(63/350)比12.1%(19/157),χ^(2)=2.781,P=0.117];≥60岁患者有营养风险率明显高于<60岁患者[25.9%(62/239)比7.5%(20/268)],差异有统计学意义(χ^(2)=31.819,P<0.01)。有营养风险患者年龄、营养不良发生率和术前营养支持率明显高于无营养风险患者[(65.3±12.7)岁比(55.9±8.9)岁、13.4%(11/82)比0和24.4%(20/82)比2.6%(11/425)],差异有统计学意义(P<0.01);有营养风险患者和无营养风险患者性别构成、肿瘤来源、术后营养支持率及手术前后白蛋白比较差异无统计学意义(P>0.05)。术前31例营养支持患者中,肠外营养(PN)1例,肠内营养(EN)30例;术后453例营养支持患者中,PN 297例,EN 27例,PN+EN 129例。结论肝癌患者围手术期营养风险的发生率较高,尤其对于老年患者应注意营养支持。NRS 2002是进行营养评估的有效工具,适用于肝癌患者围手术期营养风险筛查,可为临床营养治疗提供依据。

Objective To study the nutritional risk and nutritional support in patients with liver cancer during perioperative period.Methods In Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical,the clinical data of 507 liver cancer patients who underwent surgery College from January 2019 to January 2020 were retrospectively analyzed.The perioperative nutrition was assessed by nutritional risk screening 2002(NRS 2002),≥3 scores was diagnosed nutritional risk,and the nutritional support was counted.Results Among 507 patients,82 cases(16.2%)had nutritional risk.There was no statistical difference in rate of nutritional risk between male and female:15.3%(58/379)vs.18.8%(24/128),χ^(2)=0.838,P>0.05.There was no statistical difference in rate of nutritional risk between primary liver cancer patients and secondary liver cancer patients:18.0%(63/350)vs.12.1%(19/157),χ^(2)=2.781,P>0.05.The rate of nutritional risk in≥60 years old patients was significantly higher than that in<60 years old patients:25.9%(62/239)vs.7.5%(20/268),and there was statistical difference(χ^(2)=31.819,P<0.01).The age,incidence of dystrophy and rate of nutritional support before surgery in patients with nutritional risk were significantly higher than those in patients without nutritional risk:(65.3±12.7)years old vs.(55.9±8.9)years old,13.4%(11/82)vs.0 and 24.4%(20/82)vs.2.6%(11/425),and there were statistical differences(P<0.01);there were no statistical differences in sex composition,tumor origin,rate of nutritional support after surgery and albumin between patients with nutritional risk and patients without nutritional risk(P>0.05).Among 31 nutritional support patients before surgery,parenteral nutrition(PN)was in 1 case,enteral nutrition(EN)was in 30 cases;among 453 nutritional support patients after surgery,PN was in 297 cases,EN was in 27 cases,and PN+EN was in 129 cases.Conclusions The incidence of nutritional risk in patients with liver cancer during perioperative period is high,and especially elderly patients should pay attention to nutritional support.NRS 2002 is a powerful tool and should be recommended to use at patients with liver cancer,and provide the evidence of nutritional therapy.