CAJ | 학술논문

目的探讨存在营养风险的结直肠癌手术患者,联合肠内与肠外营养模式对临床结局的影响.方法采用不同年份的队列对比研究方法,按回顾性研究计划得到两个群体.2009至2010年按入院次序,收集到的符合研究标准的患者30例为研究群体,均接受结直肠癌手术,住院后第1天进行营养风险筛查,评分≥3分给予营养支持；术前3d完全口服肠内营养制剂进行肠道准备,不用任何泻药和灌肠；术后进行肠外联合肠内营养支持.对照群体为2007至2008年30例同类患者,术前不进行任何营养评价,常规肠道准备(控制饮食、口服泻药和灌肠),术后均单纯接受肠外营养支持,比较两群体术后营养指标的变化和全身炎性反应综合征的发生率、感染并发症的发生率、术后住院时间.结果两群体术后分别接受相近能量的、不同途径的营养支持,在体重变化和血浆前白蛋白水平的变化方面差异均无统计学意义(P＞0.05),在临床结局指标方面,研究群体全身炎性反应综合征的发生率(13.3％)、感染并发症的发生率(10.0％)和术后住院时间[(12.3±6.5)d]显著低于对照群体[分别为33％、30％、(15.0±7.2)d],差异具有统计学意义(P=0.038,P=0.042,P=0.045).结论对于结直肠癌手术患者,入院时应进行营养风险筛查,有营养风险者,术前口服肠内营养支持清洁肠道,术后联合营养支持有益于改善临床结局.
목적 탐토존재영양풍험적결직장암수술환자,연합장내여장외영양모식대림상결국적영향.방법 채용불동년빈적대렬대비연구방법,안회고성연구계화득도량개군체.2009지2010년안입원차서,수집도적부합연구표준적환자30례위연구군체,균접수결직장암수술,주원후제1천진행영양풍험사사,평분≥3분급여영양지지；술전3d완전구복장내영양제제진행장도준비,불용임하사약화관장；술후진행장외연합장내영양지지.대조군체위2007지2008년30례동류환자,술전불진행임하영양평개,상규장도준비(공제음식、구복사약화관장),술후균단순접수장외영양지지,비교량군체술후영양지표적변화화전신염성반응종합정적발생솔、감염병발증적발생솔、술후주원시간.결과 량군체술후분별접수상근능량적、불동도경적영양지지,재체중변화화혈장전백단백수평적변화방면차이균무통계학의의(P＞0.05),재림상결국지표방면,연구군체전신염성반응종합정적발생솔(13.3％)、감염병발증적발생솔(10.0％)화술후주원시간[(12.3±6.5)d]현저저우대조군체[분별위33％、30％、(15.0±7.2)d],차이구유통계학의의(P=0.038,P=0.042,P=0.045).결론 대우결직장암수술환자,입원시응진행영양풍험사사,유영양풍험자,술전구복장내영양지지청길장도,술후연합영양지지유익우개선림상결국.
Objective To explore the clinical outcome of the combined nutrition support for colorectal cancer patients.Methods Two research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.Results There were no significant difference in body weight and plasma albumin between these two arms ( P ＞ 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 ％ ),infectious complications (10.0％ ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33％,30％,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.