CAJ | 학술논문

目的调查潍坊某三甲医院接受根治手术的早、中期(Ⅰ、Ⅱ、Ⅲ期)胃肠道癌患者的营养风险、营养不足和营养支持应用情况.方法采用定点连续抽样的方法调查潍坊市某三甲医院2010年12月至2011年8月、2011年11月至2012年10月肿瘤外科、肛肠外科、普通外科住院患者8390例,进入录入登记.排除住院不足24 h、年龄＜18岁或＞90岁、神志不清、拒绝参加研究的患者153例,收录8237例.排除不符合预定诊断的病例后,筛出手术及病理证实为早、中期的胃肠道癌患者300例(3.6％,300/8390).在患者入院后48 h内采用营养风险筛查2002(NRS 2002)进行营养风险筛查,调查营养不足发生率,记录患者住院期间的营养支持应用状况.结果在300例入选患者中,共有早中期胃癌根治术患者141例,早中期结直肠癌根治术患者159例.总营养风险发生率为61.7％ (185/300).以NRS 2002中营养受损部分的评分≥3分来计算营养不足发生率为12.3％ (37/300),以体重指数＜18.5 kg/m2计算营养不足发生率为10.0％ (30/300).有营养风险的185例患者中,165例接受了营养支持(89.2％)；无营养风险的115例患者中,99例接受了营养支持(86.1％).肠外营养与肠内营养的应用例数比为82∶1.能量摄入为(78.1±24.8) kJ/ (kg·d)[(18.6±5.9 kcal/ (kg· d)],氮摄入量为(0.10±0.06)g/(kg·d),热氮比为(244±164)∶1.结论早、中期(Ⅰ、Ⅱ、Ⅲ期)胃肠道癌患者营养风险发生率为61.7％,营养不足发生率为10.0％～ 12.3％.对这部分患者的营养支持很不规范,无营养风险患者的营养支持率高达86.1％.还需要在医院开展大范围、反复的“肠内与肠外营养临床诊疗指南”培训.
목적 조사유방모삼갑의원접수근치수술적조、중기(Ⅰ、Ⅱ、Ⅲ기)위장도암환자적영양풍험、영양불족화영양지지응용정황.방법 채용정점련속추양적방법조사유방시모삼갑의원2010년12월지2011년8월、2011년11월지2012년10월종류외과、항장외과、보통외과주원환자8390례,진입록입등기.배제주원불족24 h、년령＜18세혹＞90세、신지불청、거절삼가연구적환자153례,수록8237례.배제불부합예정진단적병례후,사출수술급병리증실위조、중기적위장도암환자300례(3.6％,300/8390).재환자입원후48 h내채용영양풍험사사2002(NRS 2002)진행영양풍험사사,조사영양불족발생솔,기록환자주원기간적영양지지응용상황.결과 재300례입선환자중,공유조중기위암근치술환자141례,조중기결직장암근치술환자159례.총영양풍험발생솔위61.7％ (185/300).이NRS 2002중영양수손부분적평분≥3분래계산영양불족발생솔위12.3％ (37/300),이체중지수＜18.5 kg/m2계산영양불족발생솔위10.0％ (30/300).유영양풍험적185례환자중,165례접수료영양지지(89.2％)；무영양풍험적115례환자중,99례접수료영양지지(86.1％).장외영양여장내영양적응용례수비위82∶1.능량섭입위(78.1±24.8) kJ/ (kg·d)[(18.6±5.9 kcal/ (kg· d)],담섭입량위(0.10±0.06)g/(kg·d),열담비위(244±164)∶1.결론 조、중기(Ⅰ、Ⅱ、Ⅲ기)위장도암환자영양풍험발생솔위61.7％,영양불족발생솔위10.0％～ 12.3％.대저부분환자적영양지지흔불규범,무영양풍험환자적영양지지솔고체86.1％.환수요재의원개전대범위、반복적“장내여장외영양림상진료지남”배훈.
Objective To investigate the nutritional risk,undemutrition,and nutrition support in inpatients with early and middle stage gastrointestinal cancer undergoing radical surgery in a tertiary hospital in Weifang,Shandong Province.Methods A total of 8390 inpatients who were treated in the departments of oncological surgery,enterohepatic surgery,and general surgery in our hospital were consecutively recorded from December 2010 to August 2011 and from November 2011 to October 2012.After 153 patients were excluded for hospital length of stay less than 24 hours,age less than 18 years old or more than 90 years old,obnubilation,and/or refusal to participate in the research,8237 patients were sampled.After patients who did not meet the scheduled diagnosis were excluded,300 pathology-confirmed patients with early or middle stage gastrointestinal cancer were enrolled.Nutritional Risk Screening 2002 (NRS 2002) was performed within the first 48 hours after admission and nutrition support was evaluated until the discharge.Results A total of 300 early and middle stage gastrointestinal cancer patients (141 cases of gastric cancer and 159 cases of colorectal carcinoma) who underwent radical surgery met the inclusion criteria.Among them 185 (61.7％) were at nutritional risk.The undernutrition rate was 12.3％ (37/300) if evaluated from the score of nutritional defect part of NRS 2002,and 10.0％ (20/300) if based on body mass index ＜18.5 kg/m2.Totally 165 patients (89.2％) at nutritional risk and 99 patients (86.1％) without nutritional risk received nutrition support.The average ratio of parenteral nutrition to enteral nutrition was 82:1.The intake of calories was (78.1±24.8) k1/(kg,d) [(18.6±5.9)kcal/(kg·d)] and that of nitrogen was (0.10±0.06) g/(kg · d),yielding a ratio of calories vs.nitrogen of (244 ± 164)∶1.Conclusions Inpatients with early and middle stage gastrointestinal cancer tend to have high nutritional risk.The undernutrition rate is 10％-12.3％ in this population.Meanwhile,the application of nutrition support should be further standardized,particularly for patients without nutritional risk.