CAJ | 학술논문

目的调查老年胃肠道肿瘤患者入院时的营养风险和住院期间的营养支持状况,分析营养风险、营养支持与临床结局的关系. 方法选择2009年9月至2011年11月我院普外科收治的老年胃肠道肿瘤住院患者,采用营养风险筛查2002(NRS 2002)进行营养风险筛查,并调查患者营养支持状况,统计并发症的发生率、住院时间和住院费用. 结果共有592例老年患者纳入本研究,患者营养不足的发生率为14.0％ (83/592),营养风险的发生率为43.7％(259/592).在具有营养风险的259例患者中,营养支持率为79.2％;无营养风险的333例患者中,营养支持率为62.2％;其中肠外营养(PN)141例,肠内营养(EN) 64例,PN联合EN 49例,PN∶EN比值为2.2∶1.存在营养风险的患者术后并发症的发生率、平均住院时间和总住院费用分别为39.8％ (103/259)、(17.1士4.8)d和(62 191.5±4 251.2)元,均明显高于无营养风险患者20.4％ (68/333)、(12.6±3.6)d和(46 792.3±3 115.4)元(x2=26.55,t=13.03、50.84,均P＜0.01).在具有营养风险的259例患者中,获得营养支持患者并发症的发生率36.8％(75/205),明显低于未获得营养支持患者的发生率45.9％(20/44)(x2=19.38,P＜0.01);获得营养支持的老年胃癌患者、大肠癌患者的平均住院时间(15.6±3.5)d、(12.1±4.8)d,明显低于未获得营养支持的患者(18.1±5.4)d、(15.2±3.2)d(t=2.86、3.62,均P＜0.05). 结论老年胃肠道肿瘤住院患者存在着营养风险,营养风险与临床结局有关;对有营养风险的老年胃肠道肿瘤患者给予营养支持可以改善临床结局.
목적 조사노년위장도종류환자입원시적영양풍험화주원기간적영양지지상황,분석영양풍험、영양지지여림상결국적관계. 방법 선택2009년9월지2011년11월아원보외과수치적노년위장도종류주원환자,채용영양풍험사사2002(NRS 2002)진행영양풍험사사,병조사환자영양지지상황,통계병발증적발생솔、주원시간화주원비용. 결과 공유592례노년환자납입본연구,환자영양불족적발생솔위14.0％ (83/592),영양풍험적발생솔위43.7％(259/592).재구유영양풍험적259례환자중,영양지지솔위79.2％;무영양풍험적333례환자중,영양지지솔위62.2％;기중장외영양(PN)141례,장내영양(EN) 64례,PN연합EN 49례,PN∶EN비치위2.2∶1.존재영양풍험적환자술후병발증적발생솔、평균주원시간화총주원비용분별위39.8％ (103/259)、(17.1사4.8)d화(62 191.5±4 251.2)원,균명현고우무영양풍험환자20.4％ (68/333)、(12.6±3.6)d화(46 792.3±3 115.4)원(x2=26.55,t=13.03、50.84,균P＜0.01).재구유영양풍험적259례환자중,획득영양지지환자병발증적발생솔36.8％(75/205),명현저우미획득영양지지환자적발생솔45.9％(20/44)(x2=19.38,P＜0.01);획득영양지지적노년위암환자、대장암환자적평균주원시간(15.6±3.5)d、(12.1±4.8)d,명현저우미획득영양지지적환자(18.1±5.4)d、(15.2±3.2)d(t=2.86、3.62,균P＜0.05). 결론 노년위장도종류주원환자존재착영양풍험,영양풍험여림상결국유관;대유영양풍험적노년위장도종류환자급여영양지지가이개선림상결국.
Objective To evaluate a relationship between the nutritional risk and nutritional support in elderly hospitalized patients (aged ≥ 65 years) with gastrointestinal cancer,and to analyze the relationship between nutrition support and clinical outcomes.Methods Elderly hospitalized patients with gastrointestinal cancer were recruited from September 2009 to November 2011.Patients were screened using Nutritional Risk Screening 2002 (NRS 2002) on admission.Data were collected on the application of nutrition support,including complication rate,length of hospital stay and medical care costs.Results In 592 recruited patients,the malnutrition rate was 14.0％ (83/592) and the rate of a validated nutrition risk was 43.7％ (259/592).79.2％ of patients with nutritional risk received nutritional support while 62.2％of non-risk patients received nutritional support.The case numbers of paraenteral nutrition (PN),enteral nutrition(EN) and paraenteral nutrition + enteral nutrition(PN + EN) were 141,64 and 49 respectively,with the PN:EN ratio of 2.2 ∶ 1.The rate of postoperative complications,lengths of hospital stay and medical care cost were higher in patients with nutritional risk than without nutritional risk[complications 39.8 ％ (103/259) vs.20.4 ％ (68/333),lengths of hospital stay (17.1±4.8) d vs.(12.6±3.6) d,medical care cost(62 191.5 ±4 251.2) RMB vs.(46 792.3±3 115.4) RMB,x2 =26.55 or t=13.03,50.84 respectively,all P＜ 0.01].The average of the rate of postoperative complication [36.8 ％ (75/205) vs.45.9％ (20/44),x2 =19.38,P＜0.01],length of hospital stay [(15.6±3.5) d vs.(18.1±5.4) d,(12.1±4.8) d vs.(15.6±3.5) d,P＜0.05 or 0.01] and medical care cost[62843.3±3491.7) RMB vs.(68925.1± 4633.2) RMB,(53410.5±1954.3) RMBvs.(59857.3±3221.6) RMB,allP＜0.05 or0.01] were lower or shorter in elderly gastric cancer or colorectal cancer patients with nutritional support than in patients without nutritional support.Conclusions A considerable numbers of elderly hospitalized patients with gastrointestinal cancer are at nutritional risk.There is significant relationship between the nutritional risk and clinical outcome.Nutritional support for elderly hospitalized patients with nutritional risk may improve the clinical outcome.