老年结直肠癌患者营养风险筛查及术后早期肠内营养支持的临床研究

Clinical study about nutritional risk screening and early postoperative enteral nutrition support in elderly patients with colorectal cancer

目的了解老年结直肠癌患者营养风险状况,并探讨术后早期肠内营养支持对老年结直肠癌患者的临床疗效。方法采用营养风险筛查2002(NRS2002)表评估98例老年结直肠癌患者术前的营养风险,并将有营养风险的89例患者采取抽签法随机分为早期肠内营养组46例和早期禁食组(早期禁食,患者通气后普通流质饮食)43例,对早期肠内营养组的患者术后第1天开始行营养液缓慢输注,早期禁食组患者通气后给予常规流质饮食,对两组患者于术后1周再次行营养风险评估,并比较两组患者术后身体恢复情况、并发症发生情况及免疫指标等情况(通气时间、发热持续时间、肠瘘、切口感染、切口裂开、肺部感染、泌尿系感染等情况及白蛋白、血常规和C反应蛋白等指标)。结果有89例患者术前存在营养风险,占老年结直肠癌术后患者的91%。与非早期肠内营养组相比较,早期肠内营养组患者术后通气时间明显缩短[(55.3±6.8)h比(73.5±7.9)h](P<0.05),并发肺部感染的患者例数明显减少(P<0.05),且患者的术后住院时间显著缩短[(8.5±1.6)d比(11.3±2.1)d](P<0.05)。结论对老年结直肠癌切除术后患者进行早期营养风险筛查,并对有营养风险的患者术后行早期肠内营养,可有效改善术后营养状况,有利于患者的早期康复、减少并发症、缩短住院日。

Objective To understand the nutritional risk of elderly patients with colorectal cancer,and to explore the clinical effect of early postoperative enteral nutrition support on elderly patients with colorectal cancer. Methods The nutritional state of 98 cases of elderly patients with colorectal cancer were assessed by nutritional risk screening 2002( NRS2002) before operation. Eighty-nine patients with nutritional risk were selected and randomly divided into early enteral nutrition group( 46 cases) and early fasting group( early fasting,ventilated patients after general liquid diet,43 cases). The nutrient solution was slowly infused at the first day after operation in the early enteral nutrition group,and the early fasting group patients were given routine liquid diet after ventilation. Nutritional risk assessment was performed again one week later after operation in two groups. The postoperative rehabilitation,incidence of complications and immune indicators,etc were compared between two groups. Results A total of 89 cases with preoperative nutritional risk,accounting for 91% of all individuals. Compared with the fasting group,the postoperative ventilation time[( 55. 3 ± 6. 8) h VS.( 73. 5 ± 7. 9) h]( P < 0. 05) and postoperative hospital stays[( 8. 5 ± 1. 6) d VS.( 11. 3 ± 2. 1) d]( P < 0. 05) were significantly shorter in the early enteral nutrition group. Conclusion Early nutritional risk screening in elderly patients with colorectal cancer after tumor resection and early enteral nutrition support in patients with nutritional risk can improve the nutritional status of postoperative,helpful to the early rehabilitation,reduce complications and shorten the hospitalization days.