全程营养管理在食管癌手术患者中的应用

Application of whole course nutritional management in patients with esophageal cancer undergoing surgery

目的:探讨全程营养管理对食管癌手术患者预后及营养状态的影响。方法:采取连续性方便取样的方法从2019年至2020年纳入于某肿瘤专科医院胸外科门诊就诊的细胞或组织学证实为食管鳞癌的患者100例为研究对象(研究组),从术前门诊开始就由营养师进行营养风险筛查,并根据“营养不良五阶梯治疗原则”进行营养干预,营养干预一直到术后1个月。同时回顾性连续性调查2017年至2018年细胞或组织学证实为食管鳞癌,于胸外科行首次食管鳞癌根治手术的100例住院患者为对照组,比较两组患者术后1个月的并发症发生率、住院时间及营养状态的变化。结果:术后1个月研究组患者并发症发生率明显低于对照组(32%vs 48%),差异具有统计学意义(P<0.05);研究组患者平均住院时间少于对照组[(22.56±11.37)天vs(26.98±14.20)天],差异具有统计学意义(P<0.05)。术后1个月,研究组白蛋白(albumin,ALB)、血红蛋白(hemoglobin,HGB)、白细胞(white blood cell,WBC)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、预后营养指数(prognosticnutritional index,PNI)明显优于对照组,差异均有统计学意义(P<0.05)。结论:全程营养管理可明显降低食管癌术后并发症发病率,改善营养状态,改善预后。

Objective:To explore the effect of whole-course nutritional management on the prognosis and nutritional status of patients undergoing esophageal cancer resection.Methods:100 patients with esophageal cancer were included in the study from 2019 to 2020.NRS 2002 and PG-SGA were adopted for nutrition screening and evaluation,from preoperative outpatient to hospitalization.The patients received nutritional intervention according to the"five-step treatments for malnutrition"lastuntil 1 month after surgery.At the same time,100 patients with esophageal cancer were investigated retrospectively from 2017 to 2018.The complications and nutritional status of the two groups were compared.Results:The incidence of complications and hospital stay in the study group was significantly lower than those in the control group[32%vs 48%,(22.56±11.37)d vs(26.98±14.20)d],and the differences were statistically significant(P<0.05).1 month after surgery,the level of ALB,HGB,WBC,NLR and PNI in study group were significantly better than those in the control group,and the differences were statistically different(P<0.05).Conclusion:Whole-course nutritional management can significantly reduce the incidence of postoperative complications in patients with esophageal cancer,improve nutritional status and prognosis.