食管癌患者术前营养风险评估与干预的效果评价  

The effectiveness of nutritional risk assessment and interventions in patients with esophageal cancer

作　　者：李燕[1] 程垚[1] 徐斌[1] 段晓峰[1] 徐杰[1] 齐大亮[1] 

机构地区：[1]天津市天津医科大学肿瘤医院胸科,300060

出　　处：《中华护理杂志》2015年第2期166-170,共5页Chinese Journal of Nursing

基　　金：天津市卫生局科研基金资助项目(2010KZ78)

摘　　要：目的探讨食管癌患者术前行营养风险筛查与干预对术后营养状态的影响。方法选取2012年10月至2013年4月天津医科大学肿瘤医院手术治疗的食管癌患者,经患者主观整体营养评估(PG-SGA)将具有轻、中度营养不良的113例患者分为实验组58例和对照组55例。实验组开展营养干预2周后手术治疗,对照组术前进行常规术前治疗与饮食指导。比较两组患者术后营养指标、平均住院天数及术后并发症的发生率。结果在术前营养支持结束时,实验组前白蛋白及转铁蛋白水平与对照组相比,差异具有统计学意义(P<0.05);术后2周实验组与对照组比较,前白蛋白、视黄醇结合蛋白和转铁蛋白水平的差异具有统计学意义(P<0.05),而铁蛋白改变不明显(P=0.239);术后并发症:实验组发生率为19.0%,对照组23.6%,差异无统计学意义(P>0.05);肺部并发症及切口感染发生率:实验组为8.62%,对照组为21.82%,差异有统计学意义(P=0.041);术后平均住院日:实验组为16d,而对照组19d,比对照组少3d,但差异无统计学意义(P=0.104)。结论轻、中度营养不良的食管癌患者术前给予积极的营养支持治疗,对改善患者围手术期的营养状态,减少术后并发症,降低手术风险,具有重要的临床意义。Objective To evaluate the effect of nutritional risk screening and interventions on postoperative nutri- tional status in patients with esophageal cancer. Methods A total of 113 esophageal cancer patients with mild or moderate nutritional risk rated by patient-generated subjective global assessment（PG-SGA） from October 2012 to April 2013 were randomized into an experimental group（n=58） and a control group（n=55）. The patients in the experimental group received 2-week nutritional intervention before the operation,while the patients in the control group received routine preoperative treatment and diet guidance. The biochemical measurements of postoperative nutritional status. postoperative complications and hospital stays were compared between the two groups. Results The levels of prealburain and transferrin before the operation,and the levels of prealbumin,transferriu and retinol-binding protein at two weeks after the operation in the experimental group were significantly higher than those in the control group（P〈0.05）, while no significant difference was found in the level of ferritin between the two groups（P=0.239）. There was no significant difference in the hospital stay （P=-0.104） and the total rate of postoperative complications between the two groups（19.0% vs. 23.6%,P〉0.05）,but the incidence of infection-associated complications such as pneumonia and incision infection in the experimental group was significantly lower than that in the control group（8.62% vs. 21.82%,P=0.041）. Conclusion Preoperative nutritional support can effectively improve the perioperative nutritional status,decrease postoperative complications and operative risk in esophageal cancer patients with mild or moderate nutritional risk.

关 键 词：食管肿瘤 手术前护理 营养支持 

分 类 号：R473.73[医药卫生—护理学]