术前营养风险筛查对胃癌和结肠癌患者围手术期营养支持的临床意义

Significance of preoperative nutritional risk screening in peri-operative nutritional support for gastric and colorectal cancer patients

摘要:

目的  讨论术前营养风险筛查对胃癌和结直肠癌患者术后并发症的预测作用，以及对围手术期营养支持的指导作用，为临床合理开展营养支持治疗提供依据。方法  回顾性研究2015年1月-2015年12月在中南大学湘雅医院普通外科行根治性切除的436例胃癌患者和713例结直肠癌患者，根据营养风险筛查2002（NRS 2002）结果，将两类肿瘤患者分别分为存在营养风险和不存在营养风险患者，再分别比较两种同类肿瘤患者中，行营养支持和未行营养支持患者手术前、后血红蛋白（Hb）、白蛋白（Alb）、前白蛋白（PA）水平以及术后并发症发生率和术后住院时间。结果  436例胃癌患者中205例术前存在营养风险，不存在营养风险231例。未行术前营养支持治疗的患者术后Hb、Alb、PA水平均低于行术前营养支持的患者（P <0.05），术后并发症的发生率和术后住院时间亦高于或长于后者（P <0.05）。713例结直肠癌患者中，311例术前存在营养风险，不存在营养风险402例。未行术前营养支持治疗的患者术后并发症的发生率和术后住院时间高于或长于行术前营养支持的患者（P <0.05），手术前后Hb、Alb、PA比较，差异无统计学意义（P >0.05）。结论  术前营养支持治疗能够降低有营养风险的胃癌和结直肠癌患者的术后并发症发生率，缩短住院时间，有效改善预后。

Abstract:

Objective To explore the effect of pre-operative nutritional risk screening on predicting the incidence of post-operative complications and guiding peri-operative nutritional support therapy in gastro-colorectal cancer patients. Methods A retrospective study was performed on 436 gastric cancer patients and 713 colorectal cancer patients who received radical resection in the Department of General Surgery of Xiangya Hospital in Central South University from January to December 2015. All of the included patients were divided into nutritional-risk group and non-risk group according to the Nutritional Risk Screening 2002 (NRS 2002). Serum hemoglobin (Hb), albumin (Alb) and prealbumin (PA) levels, postoperative complications and postoperative duration of hospital stay were compared between the patients with and the patients without nutritional support in both groups. Results For the gastric cancer patients, 205 out of 436 cases were at nutritional risk. Postoperative serum Hb, Alb and PA levels of the patients without nutritional support therapy were lower than those of the patients undertaking nutritional support therapy (P < 0.05). Likewise, lower incidence of postoperative complications and shorter postoperative hospital stay were observed in the gastric cancer patients undertaking nutritional support therapy (P < 0.05). Among the 713 colorectal cancer patients, 311 were at nutritional risk. Lower incidence of postoperative complications and shorter postoperative hospital stay were observed in the patients undertaking nutritional support therapy (P < 0.05). No statistically significant association was observed between pre- and post-operative serum Hb, PA or Alb level in the colorectal cancer patients (P > 0.05). Conclusions Preoperative nutritional support therapy can decrease the incidence of postoperative complications, shorten the postoperative duration of hospital stay and improve the prognosis of gastric and colorectal cancer patients with nutritional risk.