围手术期免疫营养支持对口腔癌患者手术预后的影响  

Clinical analysis of the effect of perioperative immunonutritional support on postoperative nutritional status and prognosis of patients with oral cancer

作　　者：韩新生 谭小尧 张兴安 明华伟 王华东 袁宗毅 李婷 贾佳欣 陈方园 HAN Xinsheng;TAN Xiaoyao;ZHANG Xing'an;MING Huawei;WANG Huadong;YUAN Zongyi;LI Ting;JIA Jiaxin;CHEN Fangyuan(Department of Oral and Maxillofacial Surgery, Nanchong Central hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong 637000,Sichuan, China)

机构地区：[1]南充市中心医院·川北医学院第二临床医学院口腔颌面外科,四川南充637000

出　　处：《西部医学》2021年第5期756-759,共4页Medical Journal of West China

基　　金：四川省中医药管理局课题(2020JC0080);川北医学院校级科研发展基金(CBY20-QA-Y11)。

摘　　要：目的探讨围手术期存在营养风险的口腔癌患者进行免疫营养支持治疗对患者营养状态及预后效果的影响。方法选取2016年9月~2018年9月间我院住院确诊的存在营养风险的60例口腔癌患者为研究对象,按随机数字表法分为观察组和对照组,每组30例。对照组围手术期给予饮食营养支持并辅以营养教育,观察组围手术期在饮食营养支持的基础上加用免疫营养调节制剂,术后根据营养评估实施个体化营养支持治疗。比较两组患者入院时、手术当天、手术后第7天体重指数(BMI)、肱三头肌皮褶厚度(TSF)变化;比较实验室检查指标[血清前白蛋白(PAB)、血清白蛋白(ALB)、转铁蛋白(TRF)、总淋巴细胞计数(TLC)]变化情况;比较两组患者术后不良反应(腹胀、恶心、呕吐、腹泻)发生率、术后伤口愈合情况及住院时间长短。结果入院时,两组患者BMI、TSF、PAB、ALB、TRF、TLC指标组间比较差异无统计学意义(P>0.05);BMI和TSF三个时间点无论是纵向还是横向比较,组间差异均无统计学意义(P>0.05);手术当天及术后第七天两组患者的PAB、ALB、TRF、TLC均较入院时有所改善,且观察组各项指标变化更为显著,和入院时相比差异具有统计学意义(P<0.05),且两组间比较差异仍具有统计学意义(P<0.05);观察组胃肠道不良反应发生率显著低于对照组,伤口Ⅰ期愈合例数显著高于对照组,住院时间少于对照组,组间比较差异均具有统计学意义(P<0.05)。结论围手术期间对存在营养风险的口腔癌患者给予免疫营养支持治疗,可改善围手术期营养相关的快速变化的实验室参数指标,有利于患者术后的加速康复,可显著缩短患者的住院时间,有效减少术后胃肠道不良反应的发生,可在临床推广应用。Objective To investigate the effect of nutritional status and prognosis of perioperative immunonutritional support therapy on oral cancer patients with nutritional risk.Methods 60 cases of oral cancer patients with nutritional risk diagnosed in our hospital from September 2016 to September 2018 were selected as the research objects and randomly divided into observation group and control group,30 cases in each group.The control group was given diet nutrition support and supplemented with nutrition education during the perioperative period,while the observation group was given immune nutrition regulation preparation on the basis of diet nutrition support during the perioperative period,and individualized nutrition support treatment was implemented according to the nutritional evaluation after operation.The changes of body mass index(BMI)and triceps skinfold thickness(TSF)were compared between the two groups on admission,the day of operation and the 7th day after operation.The laboratory indexes:serum prealbumin(PAB),serum albumin(ALB),transferrin(TRF)and total lymphocyte count(TLC)were compared.The incidence of abdominal distension,nausea,vomiting,diarrhea,surgical wound complications and length of hospital stay were compared between the two groups.Results At admission,there was no significant difference in BMI,TSF,PAB,ALB,TRF and TLC between the two groups(P>0.05).There was no significant difference in BMI and TSF among the three time points(P>0.05).PAB,ALB,TRF and TLC of the two groups were improved on the day of operation and the seventh day after operation,and the changes of each index in the observation group were more significant(P<0.05).The incidence of gastrointestinal complications and wound healing complications in the observation group were significantly lower than those in the control group(P<0.05),and the hospitalization time in the observation group was less than that in the control group(P<0.05).Conclusion Immunonutritional support therapy for oral cancer patients with nutritional risk during periope

关 键 词：口腔癌 营养风险评估 免疫营养支持治疗 预后 

分 类 号：R739.85[医药卫生—肿瘤]