围手术期营养筛查在加速康复外科老年患者中的应用评价

Evaluation of the application of PONS in elderly patients in accelerated rehabilitation surgery

目的探讨围手术期营养筛查(perioperative nutrition screening,PONS)工具在加速康复外科(ERAS)老年患者营养状态评估中的应用效果及推广价值。方法选取2022年3月至8月在荆州市第一人民医院肝胆外科、胃肠外科、泌尿外科等开展ERAS路径的科室拟行手术治疗的老年患者作为调查对象。采用PONS量表和营养风险筛查2002(nutritional risk screening 2002,NRS 2002)进行术前营养筛查,测量身体质量指数(BMI)、肱三头肌皮褶厚度(TSF)、小腿围(CC)等人体测量指标,检测人血白蛋白(ALB)、总蛋白(TP)、淋巴细胞计数(LYM)等实验室指标。分析PONS量表营养筛查结果与NRS 2002量表的一致性、与客观营养指标的相关性及对术后并发症的预测能力。结果根据PONS量表,评分≥1分66人,营养风险发生率为19.8%;根据NRS 2002量表,评分≥3分37人,营养风险发生率为11.1%;两种营养筛查工具评估结果具有中等一致性(Kappa=0.581,P<0.01)。Sperman相关系数分析显示,PONS量表筛查结果与BMI、TSF、CC、ALB、TP、LYM等客观营养指标具有良好相关性(P<0.01)。受试者工作特征(ROC)曲线显示,PONS量表评分曲线下面积(AUC)为0.583,最佳截点值下,PONS量表评分特异性为83.3%,PONS量表对术后并发症具有一定预测能力。结论PONS量表营养筛查结果与NRS 2002量表具有中等一致性、与客观营养指标存在良好相关性,且对术后并发症有一定预测能力,该工具在加速康复外科老年患者中应用效果较好,有推广价值。

Objective To explore the application effect and promotion value of perioperative nutritional screening tool in accelerating nutritional status assessment of elderly patients in rehabilitation surgery.Methods From March to August 2022,elderly patients who planned to undergo surgical treatment in the departments of hepatobiliary surgery,gastrointestinal surgery and urology,etc.carrying out ERAS pathway in Jingzhou First People's Hospital were selected as the investigation objects.PONS and NRS2002 were used for preoperative nutritional screening,BMI,TSF,CC and other anthropometric indicators were measured,and ALB,TP,LYM and other laboratory indicators were detected.To analyze the consistency of PONS nutritional screening results with NRS2002,its correlation with objective nutritional indexes and its ability to predict postoperative complications.Results According to PONS,the incidence of nutritional risk was 19.8%in 66 patients with scores≥1.According to NRS2002,37 people scored≥3,and the incidence of nutritional risk was 11.1%.The results of the two nutritional screening tools were moderately consistent(Kappa=0.581,P<0.01).Sperman correlation coefficient analysis showed that PONS screening results had a good correlation with BMI,TSF,CC,ALB,TP,LYM and other objective nutritional indicators(P<0.01).ROC curve showed that the PONS score AUC was 0.583,and the specificity of PONS score was 83.3%under the optimal cut-off value,indicating that PONS had certain predictive ability for postoperative complications.Conclusion The results of PONS nutritional screening are moderately consistent with NRS2002,have good correlation with objective nutritional indexes,and have certain predictive ability for postoperative complications.The application effect of PONS in accelerated rehabilitation surgery is good,and it has the value of promotion.