营养支持治疗在食管癌术后的应用价值
영양지지치료재식관암술후적응용개치
Application value of nutritional support therapy after resection of esophageal cancer
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 11期 953-956 ,共4页

    殷静静%林玉芬

    은정정%림옥분

    食管肿瘤%营养支持治疗%营养风险筛查2002 食管腫瘤%營養支持治療%營養風險篩查2002
    식관종류%영양지지치료%영양풍험사사2002
    Esophageal neoplasms%Nutritional support therapy%Nutritional Risk Screening 2002
    目的 探讨营养支持治疗在食管癌术后的应用价值.方法 回顾性分析2013年5-11月山东大学附属省立医院收治的125例食管癌患者的临床资料.58例营养风险筛查2002(NRS 2002)评分≥3分的患者设为A组,其中43例行营养支持治疗患者设为A1组,15例未行营养支持治疗患者设为A2组;67例NRS 2002评分＜3分的患者设为B组,其中29例行营养支持治疗患者设为B1组,38例未行营养支持治疗患者设为B2组.患者入院后48 h内采用NRS 2002判定营养风险.NRS 2002评分≥3分为有营养风险,＜3分为无营养风险.有营养风险患者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.肠外营养支持治疗采用静脉输注葡萄糖、脂肪乳、氨基酸中的2种.肠内营养支持治疗包括管饲和口服营养素.营养支持治疗给予能量≥10 kcal/(kg·d),持续时间≥5d.计算有营养风险患者中营养不良发生率;检测患者术前、术后3d、术后7d血清Alb和前白蛋白水平,以及术后胃肠功能恢复时间、术后住院时间.计数资料比较采用x2检验.正态分布的计量资料以-x±s表示,组间比较采用LSD-t检验,重复测量数据采用重复测量方差分析.结果 A组58例有营养风险患者中,51例患者已存在营养不良,发生率为87.9％.43例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.A组中A1组患者术前、术后3d、术后7 d Alb分别为(29.4±1.7)g/L、(29.8±1.5)g/L、(32.2±2.3)g/L,A2组分别为(28.5±1.9)g/L、(27.0±1.8)g/L、(28.3±1.7)g/L,2组变化趋势比较,差异有统计学意义(F=2.541,P＜0.05);B组中B1组分别为(35.8±1.3) g/L、(36.0±1.4) g/L、(37.4±2.1)g/L,B2组分别为(34.5±1.3)g/L、(35.3±1.7) g/L、(36.3±1.5) g/L,2组变化趋势比较,差异无统计学意义(F =0.734,P＞0.05).A组中A1组患者前白蛋白＜2.5 g/L和≥2.5 g/L例数在术前、术后3d、术后7d分别为17例和26例、13例和30例、10例和33例,A2组分别为6例和9例、9例和6例、10例和5例,2组变化趋势比较,差异有统计学意义(x2=4.183,P＜0.05);B组中B1组分别为5例和24例、6例和23例、7例和22例,B2组分别为7例和31例、9例和29例、13例和25例,2组变化趋势比较,差异无统计学意义(x2=0.795,P＞0.05).A组中A1组患者术后胃肠功能恢复时间、术后住院时间分别为(3.2±0.8)d、(11.6±1.1)d,A2组分别为(3.8±1.0)d、(15.5±2.7)d,2组比较,差异均有统计学意义(t=0.921,3.005,P＜0.05);B组中B1组患者分别为(2.7±1.0)d、(10.6±2.6)d,B2组分别为(3.2±0.8)d、(11.3±1.5)d,2组比较,差异均无统计学意义(=0.927,0.440,P＞0.05).结论 应用NRS 2002评估食管癌患者营养状况指导营养支持治疗是准确可靠的.对存在营养风险的食管癌患者,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食管癌患者术后营养状况,加速术后恢复,缩短住院时间.
    목적 탐토영양지지치료재식관암술후적응용개치.방법 회고성분석2013년5-11월산동대학부속성립의원수치적125례식관암환자적림상자료.58례영양풍험사사2002(NRS 2002)평분≥3분적환자설위A조,기중43례행영양지지치료환자설위A1조,15례미행영양지지치료환자설위A2조;67례NRS 2002평분＜3분적환자설위B조,기중29례행영양지지치료환자설위B1조,38례미행영양지지치료환자설위B2조.환자입원후48 h내채용NRS 2002판정영양풍험.NRS 2002평분≥3분위유영양풍험,＜3분위무영양풍험.유영양풍험환자응우술후진조행영양지지치료,고지환자급가속불행영양지지치료적풍험,유환자급가속자행선택.장외영양지지치료채용정맥수주포도당、지방유、안기산중적2충.장내영양지지치료포괄관사화구복영양소.영양지지치료급여능량≥10 kcal/(kg·d),지속시간≥5d.계산유영양풍험환자중영양불량발생솔;검측환자술전、술후3d、술후7d혈청Alb화전백단백수평,이급술후위장공능회복시간、술후주원시간.계수자료비교채용x2검험.정태분포적계량자료이-x±s표시,조간비교채용LSD-t검험,중복측량수거채용중복측량방차분석.결과 A조58례유영양풍험환자중,51례환자이존재영양불량,발생솔위87.9％.43례행영양지지치료환자균내수량호,무명현복통、복창、복사정황.A조중A1조환자술전、술후3d、술후7 d Alb분별위(29.4±1.7)g/L、(29.8±1.5)g/L、(32.2±2.3)g/L,A2조분별위(28.5±1.9)g/L、(27.0±1.8)g/L、(28.3±1.7)g/L,2조변화추세비교,차이유통계학의의(F=2.541,P＜0.05);B조중B1조분별위(35.8±1.3) g/L、(36.0±1.4) g/L、(37.4±2.1)g/L,B2조분별위(34.5±1.3)g/L、(35.3±1.7) g/L、(36.3±1.5) g/L,2조변화추세비교,차이무통계학의의(F =0.734,P＞0.05).A조중A1조환자전백단백＜2.5 g/L화≥2.5 g/L례수재술전、술후3d、술후7d분별위17례화26례、13례화30례、10례화33례,A2조분별위6례화9례、9례화6례、10례화5례,2조변화추세비교,차이유통계학의의(x2=4.183,P＜0.05);B조중B1조분별위5례화24례、6례화23례、7례화22례,B2조분별위7례화31례、9례화29례、13례화25례,2조변화추세비교,차이무통계학의의(x2=0.795,P＞0.05).A조중A1조환자술후위장공능회복시간、술후주원시간분별위(3.2±0.8)d、(11.6±1.1)d,A2조분별위(3.8±1.0)d、(15.5±2.7)d,2조비교,차이균유통계학의의(t=0.921,3.005,P＜0.05);B조중B1조환자분별위(2.7±1.0)d、(10.6±2.6)d,B2조분별위(3.2±0.8)d、(11.3±1.5)d,2조비교,차이균무통계학의의(=0.927,0.440,P＞0.05).결론 응용NRS 2002평고식관암환자영양상황지도영양지지치료시준학가고적.대존재영양풍험적식관암환자,술후응적겁행영양지지치료;단대술전무영양풍험환자,술후영양지지치료불시필수.합리영양지지치료능개선식관암환자술후영양상황,가속술후회복,축단주원시간.
    Objective To investigate the application value of nutritional support therapy after resection of esophageal cancer.Methods The clinical data of 125 patients with esophageal cancer who were admitted to the Shandong Provincial Hospital Affiliated to Shandong University between May and November 2013 were retrospectively analyzed.According to the Nutritional Risk Screening 2002 (NRS 2002), 58 patients with scores of NRS 2002 ≥3 were allocated to the A group including 43 receiving nutritional support therapy in the A1 group and 15 receiving no nutritional support therapy in the A2 group;67 patients with scores of NRS 2002 ＜ 3 were allocated to the B group including 29 receiving nutritional support therapy in the B1 group and 38 receiving no nutritional support therapy in the B2 group.The NRS 2002 was used as a screening tool of nutritional risk within 48 hours after admission.There was nutritional risk in patients with scores of NRS 2002 ≥ 3 and no nutritional risk in patients with scores of NRS 2002 ＜ 3.Patients and their families would choose whether or not underwent nutritional support therapy after the risks being informed.Parenteral nutritional support therapy used any 2 kinds of intravenously infusions of glucose, fat emulsion and amino acid, and enteral nutritional support therapy included tube feeding enteral nutrition or oral nutriments.The calories ≥ 10 kcal/(kg · d) were offered for more than 5 days.The incidence of malnutrition in patients with nutritional risk was calculated, and the level of serum Alb and prealbumin before operation, at postoperative day 3 and day 7, postoperative recovery time of gastrointestinal function and duration of hospital stay were detected.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as-x ± s.Comparison among groups was analyzed using the LSD-t test, and repeated measures data were analyzed by the repeated measures ANOVA.Results Of 58 patients in the A group, 51 patients were complicated with malnutrition with a incidence of 87.9％, and nutritional support therapy in 43 patients was well tolerated without abdominal pain, distension and diarrhea.The level of serum Alb before operation, at postoperative day 3 and day 7 were (29.4 ± 1.7) g/L, (29.8 ± 1.5) g/L, (32.2 ± 2.3) g/L in the A1 group, (28.5±1.9)g/L, (27.0±1.8)g/L, (28.3 ±1.7)g/L in the A2 group, (35.8±1.3)g/L, (36.0± 1.4) g/L, (37.4 ± 2.1) g/L in the B1 group and (34.5 ± 1.3) g/L, (35.3 ± 1.7) g/L, (36.3 ± 1.5) g/L in the B2 group, showing a significant difference in the changing trends between the A1 and A2 groups (F =2.541, P ＜0.05) and no significant difference between the B1 and B2 groups (F =0.734, P ＞ 0.05).The number of patients with level of prealbumin ＜2.5 g/L and ≥2.5 g/L before operation, at postoperative day 3 and day 7 were 17 and 26, 13 and 30, 10 and 33 in the A1 group, 6 and 9, 9 and 6, 10 and 5 in the A2 group, 5 and 24, 6 and 23, 7 and 22 in the B1 group and 7 and 31, 9 and 29, 13 and 25 in the B2 group, with a significant difference between the A1 and A2 groups (x2 =4.183, P ＜ 0.05) and no significant difference between the B1 and B2 groups (x2 =0.795, P ＞ 0.05).The postoperative recovery time of gastrointestinal function and duration of hospital stay were (3.2 ± 0.8) days and (11.6 ± 1.1) days in the A1 group, (3.8 ± 1.0) days and (15.5 ± 2.7) days in the A2 group, (2.7 ± 1.0) days and (10.6 ± 2.6) days in the B1 group and (3.2 ± 0.8) days and (11.3 ±1.5) days in the B2 group, with significant differences between the A1 and A2 groups (t =0.921, 3.005, P ＜0.05) and no significant difference between the B1 and B2 groups (t =0.927, 0.440, P ＞ 0.05).Conclusions Application of NRS 2002 for evaluating nutritional status and guiding nutritional support therapy in patients with esophageal cancer is accurate and trusted.The postoperative nutritional support therapy should be selectively and reasonably applied to patients with nutritional risk, and it can improve the nutritional status of patients with esophageal cancer, enhance postoperative recovery and reduce duration of hospital stay.
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