术前无营养风险的腹腔镜结直肠癌患者术后补充性肠外营养的探讨  

Supplementary Parnteral Nutrition after Laparoscopic Surgery for Colorectal Cancer Patients without Preoperative Nutritional Risk

作　　者：李培哲[1] 高恒岭[1] 吕绪昆 王金凯 李树亮[1] 刘西山[1] Li Peizhe;Gao Hengling;Lv Xukun;Wang Jinkai;Li Shuliang;Liu Xishan(Department of Gastrointestinal Surgery,The Second People' s Hospital Of Liaocheng,Linqing,Shandong,252600,China)

机构地区：[1]聊城市第二人民医院胃肠外科

出　　处：《当代医学》2019年第17期20-23,共4页Contemporary Medicine

摘　　要：目的研究术前无营养风险的腹腔镜结直肠癌患者术后给予补充性肠外营养(SPN)是否有必要,为临床营养支持治疗提供一定的循证学依据。方法参照营养风险筛查方法2002(NRS2002),筛选术前评分<3分的结直肠癌患者106例,按照术后是否给予SPN分为两组:肠内营养(EN)组和EN+SPN组,比较两组患者的术后近期营养状况以及恢复情况。结果两组患者的临床资料:性别、年龄、肿瘤部位、体质指数、肿瘤分期、术前合并症、术前是否新辅助化疗、手术时间、术中出血量以及淋巴结清扫数目的差异均无统计学意义;术后第3天和术后第6天早晚餐前平均血糖EN+SPN组显著高于EN组[(9.1±3.7)mmol/Lvs(7.5±2.9)mmol/L,F=6.139,P=0.015]、[(8.3±3.1)mmol/Lvs(6.8±2.8)mmol/L,F=6.834,P=0.010];住院费用EN+SPN组显著高于EN组[(5.1±0.3)万元vs(4.9±0.2)万元,F=16.306,P=0.000];两组患者术后第3天以及术后第6天的血清营养指标以及术后排气时间、术后并发症发生率、术后住院日差异无统计学意义。结论术前无营养风险的腹腔镜结直肠癌患者术后给予SPN与EN相比并不能使患者的近期临床结局获益,反而容易引起术后高血糖,增加患者的医疗费用。Objective Aiming to provide evidence-based medicine for the clinical nutritional support, this study was investigated whether the supplementary parenteral nutrition (SPN) after laparoscopic surgery is necessary for colorectal cancer patients without preoperative nutritional risk. Methods A total of 106 colorectal cancer patients with preoperative score of less than 3 evaluated by nutritional risk screening 2002 (NRS2002) were recruited. According to whether or not the SPN was performed after laparoscopic resection, patients were divided into two groups: enteral nutrition (EN) only and EN combined with SPN. After operation, patient nutrition and recovery were compared between the two groups. Results No significant differences were found between the two groups in general characteristics including sex, age, tumor location, body mass index, tumor stage, comorbidity, neoadjuvant chemotherapy, operative duration, intraoperative bleeding amount and number of lymph node dissection. Before breakfast and supper on the 3rd and 6th postoperative days, the mean preprandial blood glucose of EN+SPN group was significantly higher than that of EN group [(9.1±3.7) mmol/L vs (7.5±2.9) mmol/L, F=6.139, P=0.015];[(8.3±3.1) mmol/L vs (6.8±2.8) mmol/L, F=6.834, P=0.010]. Hospitalization expense of EN+SPN group was significantly higher than that of EN group[(5.1±0.3) ten thousand yuan vs (4.9±0.2) ten thousand yuan, F=16.306, P= 0.000]. Between the two groups, there were no significant differences on serum nutrition indicators after operation 3 days and 6 days, postoperative exhaust time, complication rate and postoperative hospitalization days. Conclusion Comparison with EN only, the combined use of SPN after surgery does not benefit in the short-term clinical outcome for colorectal cancer patients without preoperative nutritional risk, but prone to cause postoperative hyperglycemia and increase medical burden.

关 键 词：营养风险筛查 营养支持 补充性肠外营养 腹腔镜 结直肠癌 

分 类 号：R735.34[医药卫生—肿瘤] R459.3[医药卫生—临床医学]