老年营养风险指数与老年胃癌患者围手术期康复的关系

Relationship between GNRI and perioperative rehabilitation of elderly patients with gastric cancer

目的探究老年营养风险指数(GNRI)与老年胃癌患者围手术期营养状况、术后恢复及并发症的关系。方法采用回顾性研究,收集212例行胃癌切除术的老年胃癌患者(年龄≥60岁)为研究对象。采用GNRI对患者术前营养状况进行回顾性评估,分析GNRI与围手术期营养状况、术后恢复及并发症的关系。应用ROC曲线探讨GNRI预测术后并发症的价值。结果老年胃癌手术患者术前营养风险发生率为45.07%,GNRI≤98分的患者与GNRI>98分的患者相比,术前、术后第1天及术后第5~8天的血清总蛋白、白蛋白、前白蛋白、血红蛋白及淋巴细胞计数均有不同程度的降低(P<0.05)。GNRI<92分的患者术后住院时间较GNRI>98分的患者长(P<0.05),且随着GNRI评分的下降,并发症的发生呈现上升趋势(P<0.001)。GNRI与术后并发症关系的多因素分析显示,TNM分期为Ⅲ~Ⅳ期及GNRI<92分是并发症发生的独立危险因素,且GNRI对并发症的发生具有较好的预测价值(AUC=0.639,95%CI:0.570~0.703,P=0.001,截断值为92.21)。结论可采用GNRI对老年胃癌患者行术前营养评估,对GNRI<92.21分的患者要积极进行营养治疗,以改善围手术期营养状况,加快术后恢复,降低并发症发生率。

Objective To explore the relationship between geriatric nutritional risk index(GNRI)and perioperative nutritional status,postoperative recovery and complications in elderly patients with gastric cancer.Methods In this retrospective study,212 elderly patients(aged≥60 years)with gastric cancer who underwent gastrectomy were recruited.GNRI was used to retrospectively assess the patients′preoperative nutritional status,and analyze the relationship between GNRI and perioperative nutritional status,postoperative recovery and complications.The ROC curve was applied to explore the value of GNRI in predicting postoperative complications.Results The incidence of preoperative nutritional risk in elderly patients undergoing gastric cancer surgery was 45.07%.Compared with the patients whose GNRI>98 points,the patients whose GNRI≤98 points had different degrees of decrease in serum total protein,albumin,prealbumin,hemoglobin and lymphocyte counts before surgery,day 1 and day 5-8 after surgery(P<0.05).The patients whose GNRI<92 points had longer postoperative hospital stay than those with GNRI>98 points(P<0.05).With the decrease of GNRI scores,the incidence of complications showed an upward trend(P<0.001).The multivariate analysis of the relationship between GNRI and postoperative complications showed that TNM staging of III-IV and GNRI<92 points were independent risk factors for complications.GNRI had a good predictive value for the occurrence of complications(AUC=0.639,95%CI:0.570-0.703,P=0.001,Cut-off value:92.21).Conclusion GNRI can be used for preoperative nutritional assessment for elderly gastric cancer patients.Patients with GNRI<92.21 points should be actively given nutritional therapy to improve perioperative nutritional status,speed up postoperative recovery,and reduce the occurrence of complications.