CAJ | 학술논문

目的了解消化系统恶性肿瘤住院患者恶病质患病率及其对临床结局的影响.方法统计2012年1月至2013年12月复旦大学附属中山医院5 118例消化系统恶性肿瘤住院患者的临床资料,进行恶病质调查并对恶病质组和非恶病质组临床结局进行分析比较.结果消化系统恶性肿瘤住院患者恶病质总体患病率为15.7％ (803/5 118),胰腺癌最高为34.0％ (89/173).恶病质组与非恶病质组根治性手术切除率分别为67.1％ (539/803)与74.5％(3 214/4 315),差异有统计学意义(P =0.000).与非恶病质组相比,恶病质组术后住院时间增加[(11.5±6.2)d比(9.4±4.9)d,P=0.003],术后排气时间延长[(3.4±0.9)d比(3.2±0.8)d,P=0.013],术后进食半流质时间延长[(4.4±1.5)d比(3.9±1.3)d,P=0.002],术后28 d并发症发生率升高[31.3％ (169/539)比26.3％ (845/3 214),P=0.014],围术期输血率增加[8.9％ (48/539)比5.8％ (186/3 214),P=0.006].恶病质组术后转入ICU比例高于非恶病质组[24.3％ (131/539)比20.0％(646/3 214),P=0.026].恶病质组与非恶病质组再手术率、呼吸机支持率、病死率分别为3.2％(17/539)比1.5％ (48/3 214)、8.0％ (43/539)比5.7％ (184/3 214)、2.4％ (13/539)比1.1％(35/3 214),差异均有统计学意义(P值分别为0.006、0.042、0.011).结论消化系统恶性肿瘤住院患者常存在恶病质,特别是胰腺癌.恶病质为消化系统恶性肿瘤住院患者临床结局的不利因素.
목적 료해소화계통악성종류주원환자악병질환병솔급기대림상결국적영향.방법 통계2012년1월지2013년12월복단대학부속중산의원5 118례소화계통악성종류주원환자적림상자료,진행악병질조사병대악병질조화비악병질조림상결국진행분석비교.결과 소화계통악성종류주원환자악병질총체환병솔위15.7％ (803/5 118),이선암최고위34.0％ (89/173).악병질조여비악병질조근치성수술절제솔분별위67.1％ (539/803)여74.5％(3 214/4 315),차이유통계학의의(P =0.000).여비악병질조상비,악병질조술후주원시간증가[(11.5±6.2)d비(9.4±4.9)d,P=0.003],술후배기시간연장[(3.4±0.9)d비(3.2±0.8)d,P=0.013],술후진식반류질시간연장[(4.4±1.5)d비(3.9±1.3)d,P=0.002],술후28 d병발증발생솔승고[31.3％ (169/539)비26.3％ (845/3 214),P=0.014],위술기수혈솔증가[8.9％ (48/539)비5.8％ (186/3 214),P=0.006].악병질조술후전입ICU비례고우비악병질조[24.3％ (131/539)비20.0％(646/3 214),P=0.026].악병질조여비악병질조재수술솔、호흡궤지지솔、병사솔분별위3.2％(17/539)비1.5％ (48/3 214)、8.0％ (43/539)비5.7％ (184/3 214)、2.4％ (13/539)비1.1％(35/3 214),차이균유통계학의의(P치분별위0.006、0.042、0.011).결론 소화계통악성종류주원환자상존재악병질,특별시이선암.악병질위소화계통악성종류주원환자림상결국적불리인소.
Objective To investigate the cachexia morbidity among hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes.Method By analyzing the clinical data of 5 118 hospitalized patients with digestive system cancer in Zhongshan Hospital,Fudan University from January 2012 to December 2013,we investigated the cachexia morbidity and compared the clinical outcome between cachectic patients and noncachectic patients.Results The overall cachexia morbidity of hospitalized patients with digestive system cancer was 15.7％ (803/5 118).The highest cachexia morbidity was 34.0％ (89/173),found in patients with pancreatic cancer.In cachectic group and non-cachectic group,the overall completion rate of radical resection was 67.1％ (539/803) and 74.5％ (3 214/4 315),respectively (P =0.000).Compared to the non-cachectic group,the cachetic group had significantly longer postoperative hospital days [(11.5 ±6.2) d vs (9.4 ±4.9) d,P =0.003],slower postoperative recovery of bowel function [(3.4 ±0.9) d vs (3.2 ±0.8) d,P =0.013],longer postoperative time to intake semifluid [(4.4 ± 1.5) d vs (3.9 ± 1.3) d,P =0.002],and more postoperative complications in 28 days after surgery [8.9％ (48/539) vs 5.8％ (186/3 214),P=0.006].After surgery,131 patients in the cachectic group were transferred to the ICU,and 646 patients in non-cachectic group transferred to the ICU (24.3％ vs 20.0％,P=0.026).Compared to the non-cachecic group,the reoperation rate [3.2％ (17/539) vs 1.5％ (48/3214)],ventilator support rate [8.0％ (43/539) vs 5.7％ (184/3 214)],and mortality [2.4％ (13/539) vs 1.1％ (35/3 214)] of the cachectic group were all significantly higher (P =0.006,0.042,0.011).Conclusions Cachexia is common in hospitalized patients with digestive system cancer,especially in patients with pancreatic cancer.Cachexia has negative impact on the clinical outcomes.