两种营养风险筛查方法在加速康复模式下肝癌肝切除围手术期应用比较  

Comparison of two nutritional risk screening methods in perioperative period of hepatectomy for hepatocellular carcinoma under model of enhanced recovery after surgery

作　　者：宋鹏 毛谅[2] 卞晓洁[2] 周铁[2] 凡银银 张静[2] 孙士全 严笑鹏[2] 伏旭[2] 仇毓东[1,2] Song Peng;Mao Liang;Bian Xiaojie;Zhou Tie;Fan Yinyin;Zhang Jing;Sun Shiquan;Yan Xiaopeng;Fu Xu;Qiu Yudong(Drum Tower Clinical Medical College of Nanjing Medical University,Nanjing 210008,China;Department of Hepatobiliary and Pancreatic Surgery,Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,210008 [2]南京大学医学院附属鼓楼医院肝胆胰外科,210008

出　　处：《中华肝脏外科手术学电子杂志》2020年第3期221-226,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：江苏省医学重点人才培养项目(ZDRC2016057)。

摘　　要：目的探讨营养风险筛查2002(NRS2002)和患者自评-主观全面评定量表(PG-SGA)两种营养评估方法在肝癌肝切除加速康复模式中的应用效能。方法回顾性分析2014年1月至2018年7月在南京鼓楼医院行肝癌手术切除的90例患者临床资料。其中男75例,女15例;年龄35~74岁,中位年龄60岁。患者均签署知情同意书,符合医学伦理学规定。术前分别依据NRS2002、PG-SGA评分将患者分别分为营养不良风险组和正常营养组。两组营养指标比较采用t检验。术后并发症发生率比较采用χ2检验或Fisher确切概率法。结果NRS2002营养不良风险组患者术前平均握力(29±8)kg,明显低于正常营养组的(34±7)kg(t=-2.364,P<0.05)。NRS2002营养不良风险组术后总体并发症为73%(11/15),肺部感染发生率27%(4/15),明显高于正常营养组的43%(32/75)、4%(3/75)(χ^2=4.712,8.954;P<0.05)。PG-SGA营养不良风险组术后肺部感染发生率为15%(3/20),明显高于正常营养组6%(4/70)(χ^2=0.041,P<0.05)。结论在肝癌肝切除加速康复模式下,与PG-SGA评分相比,术前NRS2002评分能更准确反映术前患者营养状况,更有效预测术后并发症。Objective To compare the efficiency of nutritional risk screening 2002(NRS2002)and patient-generated subjective global assessment(PG-SGA)in hepatectomy for hepatocellular carcinoma(HCC)under the model of enhanced recovery after surgery(ERAS).Methods Clinical data of 90 patients undergoing hepatectomy in Nanjing Drum Tower Hospital from January 2014 to July 2018 were retrospectively analyzed.Among them,75 patients were male and 15 female,aged 35-74 years old with a median age of 60 years old.The informed consents of all patients were obtained and the local ethical committee approval was received.Prior to surgery,all patients were divided into the malnutrition risk and normal nutrition groups according to the NRS2002 and PG-SGA scores.The nutritional indexes between two groups were statistically compared by t test.The incidence of postoperative complications was compared by Chi-square test or Fisher's exact probability test.Results The preoperative average grip strength in NRS2002 malnutrition risk group was(29±8)kg,significantly less than(34±7)kg in normal nutrition group(t=-2.364,P<0.05).The incidence of postoperative complications in NRS2002 malnutrition risk group was 73%(11/15)and the incidence of pulmonary infection was 27%(4/15),significantly higher compared with 43%(32/75)and 4%(3/75)in normal nutrition group(χ^2=4.712,8.954;P<0.05).The incidence of postoperative pulmonary infection in malnutrition risk group by PG-SGA was 15%(3/20),significantly higher than 6%(4/70)in the normal nutrition group(χ^2=0.041,P<0.05).Conclusions Compared with PG-SGA score,preoperative NRS2002 score can more accurately reflect the preoperative nutritional status of patients and more effectively predict the risk of postoperative complications under the model of ERAS of hepatectomy.

关 键 词：营养状况 肝切除术 手术后并发症 围手术期医护 

分 类 号：R735.7[医药卫生—肿瘤]