肺癌患者术前营养风险状况与围手术期及预后的相关分析

Correlation analysis of preoperative nutritional risk status perioperative period and prognosis in patients with lung cancer

目的探讨肺癌患者术前营养风险状况与围手术期及预后情况的相关性。方法选取2016年4月至2019年4月于南通大学附属如皋医院心胸外科住院并拟行手术治疗的肺癌患者126例,采用营养风险筛查2002(NRS 2002)对患者进行营养风险筛查,根据评分将患者分为无营养风险组84例(NRS 2002评分<3分)和有营养风险组42例(NRS 2002评分≥3分),比较两组患者临床资料、手术情况和术后并发症情况,对患者随访3年,比较两组患者肺癌复发率及生存率。结果126例肺癌患者营养风险发生率为33.33%(42/126)。与无营养风险患者比较,术前存在营养风险患者血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)及前白蛋白(PAB)均显著降低,CRP则显著增加(P<0.05);术中出血量、术后引流量、术后疼痛时间及并发症发生率均显著增加,差异具有统计学意义(P<0.05)。Spearman相关性分析结果显示,患者术前营养风险状况与术中出血量、术后引流量、术后疼痛时间及并发症发生率呈显著正相关(r=0.487、0.546、0.639、0.432,P<0.05)。两组患者术后1年复发率(30.95%比52.38%)、生存率(88.10%比73.81%)和术后3年复发率(59.52%比83.33%)、生存率(75.00%比54.76%)比较,差异具有统计学意义(P<0.05)。结论术前存在营养风险的肺癌患者术中出血量更多,术后引流量更大,术后疼痛时间更长,术后并发症发生风险和复发率更高,预后更差。

Objective To investigate the correlation between preoperative nutritional risk and perioperative period and prognosis of patients with lung cancer.Method A total of 126 patients with lung cancer who were hospitalized in the Cardio-Thoracic Surgery of Department of Thoracic Surgery,Rugao Hospital affiliated to Nantong University and planned to receive surgical treatment from April 2016 to April 2019 were selected.The nutritional risk screening scale 2002(NRS 2002)was used to screen the patients for nutritional risk.According to the score,the patients were divided into no nutritional risk group(NRS score<3)and nutritional risk group(NRS score≥3).The clinical data,operation and postoperative complications of the two groups were compared.The patients were fllowed up for 3 years.The recurrence rate and survival rate of lung cancer in the two groups were compared.Result The incidence of nutritional risk in 126 lung cancer patients was 33.33%(42/126).Compared with patients without nutritional risk,preoperative Hb,TP,ALB and PAB of patients with nutritional risk were significantly decreased,while CRP was significantly increased(P<0.05).The amount of intraoperative blood loss,postoperative drainage volume,postoperative pain time and incidence of complications were significantly increased,with statistical significance(P<0.05).Spearman correlation analysis showed that preoperative nutritional risk status of patients was significantly positively correlated with intraoperative blood loss,postoperative drainage volume,postoperative pain time and complication rate(r=0.487,0.546,0.639,0.432,P<0.05).The recurrence rate(30.95%vs 52.38%)and survival rate(88.10%vs 73.81%)1 year after surgery were compared between the two groups,and the recurrence rate(59.52%vs 83.33%)and survival rate(75.00%vs 54.76%)3 years after surgery were compared between the two groups,with statistical significance(P<O.05).Conclusion Patients with preoperative nutritional risk have more intraoperative blood loss,greater postoperative drainage,longer postoperative pain time,higher risk of postoperative complications and recurrence rate,and worse prognosis.