原发性肝癌患者肝切除术前营养风险筛查及营养支持对营养风险患者康复效果的对照研究

A Control Study on Rehabilitation Effect of Nutritional Risk Screening and Nutritional Support before Hepatectomy in Patients with Primary Liver Cancer

目的:观察原发性肝癌(PLC)肝切除术前营养风险,并研究营养支持对营养风险患者康复效果的影响。方法:选择我院2021年7月~2021年12月期间收治的PLC患者99例,采用营养风险筛查2002(NRS2002)量表评估患者的营养风险,单因素及多因素Logistic回归分析PLC患者肝切除术前发生营养风险的影响因素。根据有无营养风险分为营养风险组(n=64)和无营养风险组(n=35),其中营养风险组患者采用随机数字表法分为术前未接受营养支持组和术前接受营养支持组,各32例。其中术前未接受营养支持组术前不接受营养支持,术前接受营养支持组术前接受营养支持,对比术前未接受营养支持组、术前接受营养支持组的康复效果。结果:经营养风险筛查结果显示,99例PLC患者中有64例术前就已存在营养风险。单因素分析结果显示,无营养风险组、营养风险组在肿瘤直径、贫血、临床分期、家庭月收入、年龄、并发乙肝方面对比存在明显差异(P<0.05)。年龄为60~岁、家庭月收入<3000元、临床分期为Ⅱ期、贫血、并发乙肝均是PLC患者肝切除术前发生营养风险的危险因素(P<0.05)。术前接受营养支持组的住院时间、首次排气时间、排便时间均短于术前未接受营养支持组(P<0.05)。两组术后7 d白蛋白、前白蛋白、血红蛋白水平均下降,但术前接受营养支持组高于术前未接受营养支持组(P<0.05)。术前未接受营养支持组、术前接受营养支持组的并发症总发生率组间对比无统计学差异(P>0.05)。结论:PLC患者肝切除术前发生营养风险的比例较高,且受到多种因素影响,术前给予营养支持可促进患者术后恢复,有效调节患者术后营养水平。

Objective:To observe the nutritional risk before hepatectomy in primary liver cancer(PLC),and to study the effect of nutritional support on the rehabilitation effect of patients with nutritional risk.Methods:99 patients with PLC who were treated in our hospital from July 2021 to December 2021 were selected.The nutritional risk of patients was evaluated by nutritional risk screening 2002(NRS2002).Univariate and multivariate Logistic regression analysis of nutritional risk influence factors in patients with PLC before hepatectomy.They were divided into nutritional risk group(n=64)and non-nutritional risk group(n=35)according to nutritional risk.Patients in the nutritional risk group were divided into the group without receiving nutritional support before surgery and the group receiving nutritional support before surgery by random number table method,32 cases in each group.Among them,the group without receiving nutritional support before surgery that did not receive nutritional support before surgery,and the group receiving nutritional support before surgery received nutritional support before surgery.The rehabilitation effect of the group without receiving nutritional support before surgery and group receiving nutritional support before surgery was compared.Results:Nutritional risk screening results showed that 64 cases of 99 PLC patients already had nutritional risk before surgery.Univariate analysis showed that there were significant differences in tumor diameter,anemia,clinical stage,monthly family income,age and complicated with hepatitis B between the non-nutritional risk group and the nutritional risk group(P<0.05).The risk factors of nutritional risk of patients with PLC before hepatectomy were age 60~years old,place of residence in rural area,monthly family income<3000 yuan,medical expense source at own expense,clinical stage Ⅱ,anemia and complicated with hepatitis B(P<0.05).The hospital stay,first exhaust time,defecation time in the group receiving nutritional support before surgery were shorter than those in the group without receiving nutritional support before surgery(P<0.05).The levels of albumin,prealbumin and hemoglobin in both groups decreased at 7 d after surgery,but those in the group receiving nutritional support before surgery were higher than those in the group without receiving nutritional support before surgery(P<0.05).There was no statistical difference in the total incidence of complications between the group without receiving nutritional support and the group receiving nutritional support before surgery(P>0.05).Conclusion:The patients with PLC have a high proportion of nutritional risks before hepatectomy and are affected by a variety of factors.Preoperative nutritional support can promote postoperative recovery and effectively regulate post-operative nutritional levels of patients.