胃癌病人术前有营养风险是临床预后不良的危险因素  

Preoperative nutritional risk is a risk factor for adverse clinical outcomes in gastric cancer patients

作　　者：王虎[1] 张海佳[1] 尚琳[1] 廉博[1] 连肖[1] 韩振宇[1] 周威[1] 李孟彬[1] 

机构地区：[1]第四军医大学附属西京医院消化外科,陕西西安710032

出　　处：《肠外与肠内营养》2017年第3期150-154,共5页Parenteral & Enteral Nutrition

基　　金：卫计委公益性行业科研专项资助(201502022)

摘　　要：目的:探讨胃癌病人术前存在营养风险对术后临床结局的影响以及预后不良的危险因素分析。方法:前瞻性观察140例胃癌病人,术前进行NRS 2002营养风险筛查,分析术前存在营养风险对术后并发症、住院时间、入住ICU时间、住院费用、60 d再入院及病死率的影响。运用单因素和多因素分析研究围手术期并发症的危险因素。结果:NRS 2002≥3分与NRS 2002<3分的病人总并发症发生率、肺部感染发生率、总住院天数和术后住院天数均有显著性差异(P<0.05);而吻合口瘘、胸腔积液发生率、60 d再入院率、60 d病死率和住院费用等方面,虽然有营养风险组略高于无营养风险组,但无统计学差异(P>0.05)。单因素和多因素分析显示,术前高总胆固醇水平和术前存在营养风险是影响病人预后的危险因素,也是发生术后并发症的独立危险因素。结论:术前存在营养风险病人的临床结局明显差于无营养风险病人,术前高总胆固醇水平和存在营养风险是围手术期并发症的独立危险因素。Objective： To investigate the influence of clinical outcomes and the risk factors of poor prognosis for preoperative nutritional risk in gastric cancer patients. Methods ： A prospective study was performed in 140 patients with gastric cancer and the nutritional risk screening 2002 （NRS 2002） was done. The influence of preoperative nutritional risk on postoperative complications, hospital stay, ICU stay, hospital expenses, 60 days readmission and mortality was analyzed, and the risk factors of perioperative complication were identified by univariate and multivariate analysis. Results： The signifi- cant difference （NRS 2002 ~〉 3 group vs. NRS 2002 〈 3 group） was observed in the rates of overall postoperative complications, pulmonary infection, overall hospital stay and postoperative hospital stay （P 〈 0.05 ）. The rates of anastomotic fistula, pleural effusion, 60 days readmission, 60 days mortality and hospitalization expenses in NRS 2002 ≥ 3 group were higher than that of NRS 2002 〈 3 group, but there were no differences between the two groups （P 〉 0.05 ）. By univariate and multivariate analysis, preoperative high cholesterol levels and preoperative nutritional risk are the risk factors of poor prognosis and postoperative complications. Conclusion： Preoperative high cholesterol levels and preoperative nutritional risk are independent risk factors of postoperative complications.

关 键 词：胃肿瘤 营养风险筛查 并发症 临床结局 危险因素 

分 类 号：R459.3[医药卫生—治疗学] R735.2[医药卫生—临床医学]