肠内营养支持治疗在结直肠癌根治术后的应用价值
장내영양지지치료재결직장암근치술후적응용개치
Application value of enteral nutritional support therapy after radical resection of colorectal cancer
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 10期 852-857 ,共6页

    吴莉%姜芸

    오리%강예

    结直肠肿瘤%营养支持治疗,肠内%营养风险筛查2002%CONUT 結直腸腫瘤%營養支持治療,腸內%營養風險篩查2002%CONUT
    결직장종류%영양지지치료,장내%영양풍험사사2002%CONUT
    Colorectal neoplasms%Nutrition support therapy,enteral%Nutritional risk screening 2002%Controlling nutritional status
    目的 探讨联合应用营养风险筛查2002(NRS 2002)和CONUT 2种营养状况评估工具对结直肠癌根治术后行营养支持治疗的指导价值及对营养支持治疗的临床意义.方法 回顾性分析2012年6月至2014年6月新疆医科大学附属肿瘤医院收治的180例行结直肠癌手术患者的临床资料.70例NRS2002评分≥3分的患者设为A组;A组中40例行营养支持治疗患者设为A1组,30例未行营养支持治疗患者设为A2组.60例NRS 2002评分＜3分且CONUT阴性的患者设为B组;B组中30例行营养支持治疗患者设为B1组,30例未行营养支持治疗患者设为B2组.50例NRS 2002评分＜3分但CONUT阳性的患者设为C组;C组中25例行营养支持治疗患者设为C1组,25例未行营养支持治疗患者设为C2组.联合应用NRS 2002和CONUT2种工具对患者营养状况进行评估.NRS 2002评分≥3分或NRS 2002评分＜3分但CONUT阳性为存在营养风险,NRS 2002评分＜3分且CONUT阴性为无营养风险.存在营养风险患者均应于术后尽早行营养支持治疗,告知患者及家属不行营养支持治疗的风险,由患者及家属自行选择.采用肠内营养支持治疗,经管饲补充肠内营养制剂或直接口服营养素,热卡≥41.84 kJ/(kg·d),时间≥3d.观察指标:(1)营养学指标:术前、术后第1天和术后第7天清晨空腹血清Alb、前白蛋白及转铁蛋白.(2)术后恢复情况:术后肛门排气时间,术后排便时间,术后进半流质食物时间,术后住院时间.正态分布的计量资料以x-±s表示,组间比较采用t检验和重复测量方差分析.计数资料比较采用x2检验.结果 3组行营养支持治疗患者均耐受良好,无明显腹痛、腹胀、腹泻情况.营养学指标比较:A组中A1组患者术前Alb、前白蛋白、转铁蛋白分别为(29 ±4) g/L、(0.25 ±0.06) g/L、(2.0 ±0.4) g/L,术后第1天分别为(27±4)g/L、(0.19 ±0.07)g/L、(1.7±0.4) g/L,术后第7天分别为(33±5)g/L、(0.27±0.05) g/L、(1.9±0.3)g/L;A2组患者术前Alb、前白蛋白、转铁蛋白分别为(29±5)g/L、(0.24 ±0.04) g/L、(2.0 ±0.4)g/L,术后第1天分别为(27±4)g/L、(0.18±0.05)g/L、(1.7 ±0.4)g/L,术后第7天分别为(26 ±4) g/L、(0.16±0.04) g/L、(1.8 ±0.5)g/L.两组上述3项指标变化趋势比较,差异均有统计学意义(F =3.256,6.642,7.152,P＜0.05).B组中B1组患者术前Alb、前白蛋白、转铁蛋白分别为(37 ±4) g/L、(0.28±0.05)g/L、(2.0±0.3)g/L,术后第1天分别为(36 ±4)g/L、(0.21±0.06)g/L、(1.7±0.5)g/L,术后第7天分别为(38±4)g/L、(0.30 ±0.05) g/L、(1.9 ±0.5)g/L;B2组患者术前Alb、前白蛋白、转铁蛋白分别为(36±4)g/L、(0.28±0.06) g/L、(2.1±0.4)g/L,术后第1天分别为(36 ±3) g/L、(0.23±0.04) g/L、(1.7±0.4) g/L,术后第7天分别为(37±4)g/L、(0.22 ±0.07) g/L、(1.8±0.5)g/L.两组上述3项指标变化趋势比较,差异均无统计学意义(F=1.562,0.625,2.223,P＞0.05).C组中Cl组患者术前Alb、前白蛋白、转铁蛋白分别为(28 ±4) g/L、(0.35±0.06) g/L、(2.1±0.4) g/L,术后第1天分别为(26±4)g/L、(0.17±0.07) g/L、(1.7±0.4)g/L,术后第7天分别为(34±5)g/L、(0.35 ±0.05) g/L、(1.8±0.3)g/L;C2组患者术前Alb、前白蛋白、转铁蛋白分别为(28±5)g/L、(0.34 ±0.04) g/L、(2.0 ±0.4)g/L,术后第1天分别为(26±4) g/L、(0.16±0.05)g/L、(1.7±0.4) g/L,术后第7天分别为(25±4)g/L、(0.16±0.04) g/L、(1.8±0.5) g/L.两组上述3项指标变化趋势比较,差异均有统计学意义(F =5.625,4.225,8.221,P＜0.05).术后恢复情况:A组中A1组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为(1.9±0.5)d、(2.3±0.5)d、(8.6±1.2)d、(14.7±1.1)d,A2组分别为(3.0±0.5)d、(4.5±0.6)d、(11.4±2.2)d、(17.8±1.3)d,两组上述指标比较,差异均有统计学意义(t=-0.644,-12.200,-8.710,-11.650,P＜0.05).B组中B1组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为(1.2±0.3)d、(3.2±0.7)d、(10.3±1.4)d、(14.7 ±2.0)d,B2组分别为(1.5±0.5)d、(3.7±0.6)d、(11.0±1.2)d、(16.1±1.5)d,两组上述指标比较,差异均无统计学意义(t=-1.929,-1.033,-1.019,-1.171,P＞0.05).C组中Cl组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为(1.8±0.7)d、(2.1±0.5)d、(7.6±1.2)d、(13.9±1.2)d,C2组分别为(3.1-±0.5)d、(4.5 ±0.7)d、(11.4±2.4)d、(17.6±1.3)d,两组上述指标比较,差异均有统计学意义(t=-5.934,-10.950,-10.010,-11.700,P＜0.05).结论 联合应用NRS 2002和CONUT 2种工具评估患者营养状况指导营养支持治疗准确可靠.对存在营养风险的结直肠癌患者,术后应积极行营养支持治疗;但对术前无营养风险患者,术后营养支持治疗不是必需.合理营养支持治疗能改善结直肠癌患者术后营养状况,加速术后恢复,缩短住院时间.
    목적 탐토연합응용영양풍험사사2002(NRS 2002)화CONUT 2충영양상황평고공구대결직장암근치술후행영양지지치료적지도개치급대영양지지치료적림상의의.방법 회고성분석2012년6월지2014년6월신강의과대학부속종류의원수치적180례행결직장암수술환자적림상자료.70례NRS2002평분≥3분적환자설위A조;A조중40례행영양지지치료환자설위A1조,30례미행영양지지치료환자설위A2조.60례NRS 2002평분＜3분차CONUT음성적환자설위B조;B조중30례행영양지지치료환자설위B1조,30례미행영양지지치료환자설위B2조.50례NRS 2002평분＜3분단CONUT양성적환자설위C조;C조중25례행영양지지치료환자설위C1조,25례미행영양지지치료환자설위C2조.연합응용NRS 2002화CONUT2충공구대환자영양상황진행평고.NRS 2002평분≥3분혹NRS 2002평분＜3분단CONUT양성위존재영양풍험,NRS 2002평분＜3분차CONUT음성위무영양풍험.존재영양풍험환자균응우술후진조행영양지지치료,고지환자급가속불행영양지지치료적풍험,유환자급가속자행선택.채용장내영양지지치료,경관사보충장내영양제제혹직접구복영양소,열잡≥41.84 kJ/(kg·d),시간≥3d.관찰지표:(1)영양학지표:술전、술후제1천화술후제7천청신공복혈청Alb、전백단백급전철단백.(2)술후회복정황:술후항문배기시간,술후배편시간,술후진반류질식물시간,술후주원시간.정태분포적계량자료이x-±s표시,조간비교채용t검험화중복측량방차분석.계수자료비교채용x2검험.결과 3조행영양지지치료환자균내수량호,무명현복통、복창、복사정황.영양학지표비교:A조중A1조환자술전Alb、전백단백、전철단백분별위(29 ±4) g/L、(0.25 ±0.06) g/L、(2.0 ±0.4) g/L,술후제1천분별위(27±4)g/L、(0.19 ±0.07)g/L、(1.7±0.4) g/L,술후제7천분별위(33±5)g/L、(0.27±0.05) g/L、(1.9±0.3)g/L;A2조환자술전Alb、전백단백、전철단백분별위(29±5)g/L、(0.24 ±0.04) g/L、(2.0 ±0.4)g/L,술후제1천분별위(27±4)g/L、(0.18±0.05)g/L、(1.7 ±0.4)g/L,술후제7천분별위(26 ±4) g/L、(0.16±0.04) g/L、(1.8 ±0.5)g/L.량조상술3항지표변화추세비교,차이균유통계학의의(F =3.256,6.642,7.152,P＜0.05).B조중B1조환자술전Alb、전백단백、전철단백분별위(37 ±4) g/L、(0.28±0.05)g/L、(2.0±0.3)g/L,술후제1천분별위(36 ±4)g/L、(0.21±0.06)g/L、(1.7±0.5)g/L,술후제7천분별위(38±4)g/L、(0.30 ±0.05) g/L、(1.9 ±0.5)g/L;B2조환자술전Alb、전백단백、전철단백분별위(36±4)g/L、(0.28±0.06) g/L、(2.1±0.4)g/L,술후제1천분별위(36 ±3) g/L、(0.23±0.04) g/L、(1.7±0.4) g/L,술후제7천분별위(37±4)g/L、(0.22 ±0.07) g/L、(1.8±0.5)g/L.량조상술3항지표변화추세비교,차이균무통계학의의(F=1.562,0.625,2.223,P＞0.05).C조중Cl조환자술전Alb、전백단백、전철단백분별위(28 ±4) g/L、(0.35±0.06) g/L、(2.1±0.4) g/L,술후제1천분별위(26±4)g/L、(0.17±0.07) g/L、(1.7±0.4)g/L,술후제7천분별위(34±5)g/L、(0.35 ±0.05) g/L、(1.8±0.3)g/L;C2조환자술전Alb、전백단백、전철단백분별위(28±5)g/L、(0.34 ±0.04) g/L、(2.0 ±0.4)g/L,술후제1천분별위(26±4) g/L、(0.16±0.05)g/L、(1.7±0.4) g/L,술후제7천분별위(25±4)g/L、(0.16±0.04) g/L、(1.8±0.5) g/L.량조상술3항지표변화추세비교,차이균유통계학의의(F =5.625,4.225,8.221,P＜0.05).술후회복정황:A조중A1조환자술후항문배기시간、술후배편시간、술후진반류질식물시간、술후주원시간분별위(1.9±0.5)d、(2.3±0.5)d、(8.6±1.2)d、(14.7±1.1)d,A2조분별위(3.0±0.5)d、(4.5±0.6)d、(11.4±2.2)d、(17.8±1.3)d,량조상술지표비교,차이균유통계학의의(t=-0.644,-12.200,-8.710,-11.650,P＜0.05).B조중B1조환자술후항문배기시간、술후배편시간、술후진반류질식물시간、술후주원시간분별위(1.2±0.3)d、(3.2±0.7)d、(10.3±1.4)d、(14.7 ±2.0)d,B2조분별위(1.5±0.5)d、(3.7±0.6)d、(11.0±1.2)d、(16.1±1.5)d,량조상술지표비교,차이균무통계학의의(t=-1.929,-1.033,-1.019,-1.171,P＞0.05).C조중Cl조환자술후항문배기시간、술후배편시간、술후진반류질식물시간、술후주원시간분별위(1.8±0.7)d、(2.1±0.5)d、(7.6±1.2)d、(13.9±1.2)d,C2조분별위(3.1-±0.5)d、(4.5 ±0.7)d、(11.4±2.4)d、(17.6±1.3)d,량조상술지표비교,차이균유통계학의의(t=-5.934,-10.950,-10.010,-11.700,P＜0.05).결론 연합응용NRS 2002화CONUT 2충공구평고환자영양상황지도영양지지치료준학가고.대존재영양풍험적결직장암환자,술후응적겁행영양지지치료;단대술전무영양풍험환자,술후영양지지치료불시필수.합리영양지지치료능개선결직장암환자술후영양상황,가속술후회복,축단주원시간.
    Objective To investigate the value of guidance and clinical significance of enteral nutritional support therapy using a joint of nutritional risk screening 2002 (NRS2002) and a screening tool for controlling nutritional status (CONUT) after radical resection of colorectal cancer.Methods The clinical data of 180 patients who underwent radical resection of colorectal cancer at the Tumor Hospital of Xinjiang Medical University between June 2012 and June 2014 were retrospectively analyzed.Seventy patients with scores of NRS 2002 ≥ 3 were allocated into the A group including 40 with enteral nutritional support therapy in the A1 group and 30 without enteral nutritional support therapy in the A2 group, 60 patients with scores of NRS 2002 ＜ 3 and negative CONUT was allocated into the B group including 30 with enteral nutritional support therapy in the B1 group and 30 without enteral nutritional support therapy in the B2 group, 50 patients with scores of NRS 2002 ＜ 3 and positive CONUT was allocated into the C group including 25 with enteral nutritional support therapy in the Cl group and 25 without enteral nutritional support therapy in the C2 group.The nutritional status of patients was evaluated using a joint of NRS 2002 and CONUT.There was nutritional risk in patients with scores of NRS 2002≥3 or scores of NRS 2002 ＜ 3 and positive CONUT and no nutritional risk in patients with scores of NRS 2002 ＜ 3 and negative CONUT.Patients and their families would choose whether or not to undergo enteral nutritional support therapy after the risks being informed.Enteral nutritional support therapy included tube feeding enteral nutrition or oral nutriments with calories ≥41.84 k J/(kg · d) for more than 3 days.Observed indicators: (l)Nutritional indicators included fasting serum albumin (Alb), prealbumin and transferrin before operation, at postoperative day 1 and day 7.(2)Postoperative recovery included time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay.Measurement data with normal distribution were presented as x ± s, comparison among groups was analyzed using the t test and repeated measures ANOVA, and count data were analyzed using the chi-square test.Results Patients in A, B and C groups had good tolerance without abdominal pain, abdominal distension and diarrhea.Comparisons of nutritional indicators: the levels of fasting serum Alb, prealbumin and transferrin in the A1 group were (29 ±4)g/L, (0.25 ±0.06)g/L and (2.0 ±0.4)g/L before operation, (27 ±4)g/L, (0.19 ± 0.07) g/L, (1.7 ± 0.4) g/L at postoperative day 1 and (33 ± 5) g/L, (0.27 ± 0.05) g/L and (1.9 ± 0.3) g/L at postoperative day 7, respectively.The levels of fasting serum Alb, prealbumin and transferrin in the A2 group were (29 ±5)g/L, (0.24 ±0.04)g/L and(2.0 ±0.4)g/L before operation, (27 ±4) g/L, (0.18 ±0.05)g/L and (1.7 ± 0.4) g/L at postoperative day 1 and (26 ± 4) g/L, (0.16 ± 0.04) g/L and (1.8 ± 0.5) g/L at postoperative day 7, respectively.There were significant differences in the changing trends of the above 3 indicators between the 2 groups (F =3.256, 6.642, 7.152, P ＜0.05).The levels of fasting serum Alb, prealbumin and transferrin in the B1 group were (37 ± 4) g/L, (0.28 ± 0.05) g/L and (2.0 ± 0.3) g/L before operation, (36 ± 4) g/L, (0.21 ± 0.06) g/L and (1.7 ± 0.5) g/L at postoperative day 1 and (38 ± 4) g/L, (0.30 ± 0.05) g/L and (1.9 ± 0.5) g/L at postoperative day 7, respectively.The levels of fasting serum Alb, prealbumin and transferrin in the B2 group were (36 ±4)g/L, (0.28 ±0.06)g/L and (2.1 ±0.4)g/L before operation, (36 ±3)g/L,(0.23 ±0.04)g/L and (1.7 ±0.4)g/L at postoperative day 1 and (37 ±4)g/L, (0.22 ±0.07)g/L and (1.8 ± 0.5) g/L at postoperative day 7, respectively.There was no significant difference in the changing trends of the above 3 indicators between the 2 groups (F =1.562, 0.625, 2.223, P ＞ 0.05).The levels of fasting serum Alb,prealbumin and transferrin in the C1 group were (28 ± 4) g/L, (0.35 ± 0.06) g/L and (2.1 ± 0.4) g/L before operation, (26 ±4)g/L, (0.17 ± 0.07)g/L and (1.7 ± 0.4)g/L at postoperative day 1 and (34 ± 5)g/L,(0.35 ±0.05)g/L and (1.8 ± 0.3)g/L at postoperative day 7, respectively.The levels of fasting serum Alb,prealbumin and transferrin in the C2 group were(28 ± 5)g/L, (0.34 ± 0.04)g/L and (2.0 ± 0.4)g/L before operation, (26 ± 4) g/L, (0.16 ± 0.05) g/L and (1.7 ± 0.4) g/L at postoperative day 1 and (25 ± 4) g/L,(0.16 ±0.04) g/L and (1.8 ±0.5)g/L at postoperative day 7, respectively.There were significant differences in the changing trends of the above 3 indicators between the 2 groups (F =5.625, 4.225, 8.221, P ＜0.05).Postoperative recovery: time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were (1.9 ± 0.5) days, (2.3 ± 0.5) days, (8.6 ± 1.2) days, (14.7 ± 1.1) days in the A1 group and (3.0 ± 0.5) days, (4.5 ± 0.6) days, (11.4 ± 2.2) days, (17.8 ± 1.3) days in the A2 group, respectively,with significant differences between the 2 groups (t =-0.644,-12.200,-8.710,-11.650, P ＜ 0.05).Time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were (1.2 ± 0.3)days, (3.2 ±0.7)days, (10.3 ± 1.4)days, (14.7 ±2.0)days in the B1 group and (1.5 ±0.5)days, (3.7 ± 0.6) days, (11.0 ± 1.2) days, (16.1 ± 1.5) days in the B2 group, respectively, with no significant difference between the 2 groups (t =-1.929,-1.033,-1.019,-1.171, P ＞0.05).Time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were (1.8 ± 0.7) days, (2.1 ± 0.5) days,(7.6±1.2)days, (13.9 ±1.2)days in the C1 group and (3.1 ±0.5)days, (4.5 ±0.7)days, (11.4±2.4)days,(17.6 ± 1.3) days in the C2 group, respectively, with significant differences between the 2 groups (t =-5.934,-10.950,-10.010,-11.700, P ＜ 0.05).Conclusions A joint application of NRS2002 and CONUT after radical resection of colorectal cancer is exact and feasible for evaluating nutritional status of patients and guiding enteral nutritional support therapy.Patients should select nutritional support therapy after operation if there is nutritional risk.The proper nutritional support therapy can improve the postoperative nutritional status of patients with colorectal cancer, enhance the postoperative recovery and reduce the duration of hospital stay.
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