肝癌合并肝硬化患者围手术期目标营养管理临床实践  

The clinical practice of goal-directed nutrition pathway management in liver cancer operative patients combined with cirrhosis

作　　者：唐小丽[1] 王海清[1] 杨洁 余佳秀 赵亚[1] 吕家华[1] 程瑜琳[1] 刘美伶[1] 邹静[1] 王静[1] 张丽霞[1] Tang Xiaoli;Wang Haiqing;Yang Jie;Yu Jiaxiu;Zhao Ya;Lyu Jiahua;Cheng Yulin;Liu Meilin;Zou Jing;Wang Jing;Zhang Lixia(Department of Hepatopancreatobiliary Surgery,Sichuan Cancer Hospital&Institute,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省肿瘤医院肝胆胰外科,成都610041

出　　处：《肿瘤代谢与营养电子杂志》2021年第4期408-413,共6页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：吴阶平医学基金会临床科研专项资助基金(320675018070)。

摘　　要：目的探索肝癌合并肝硬化患者围手术期目标营养管理对营养状况及术后康复的影响。方法成立营养支持小组,制订目标营养路径化执行单,实施入院、术前、术后、出院时、出院后目标营养全程管理。选取目标营养管理实施前肝癌手术患者121例为对照组,实施目标营养管理后肝癌手术患者126例为试验组。实时评价肠内营养疗效,动态调整目标营养。比较两组患者入院、术后14 d骨骼肌、白蛋白、前白蛋白等的变化情况,患者肠道功能恢复时间,术后并发症发生情况、平均住院日。结果试验组骨骼肌下降不明显(P<0.001),肠道功能恢复时间显著提前(P<0.001),术后14 d白蛋白及前白蛋白水平显著优于对照组(P=0.002,P=0.001),腹胀、腹泻、腹水及感染发生率显著低于对照组(P<0.001,P<0.001,P=0.002,P=0.023)。结论营养支持小组围手术期目标营养管理实施方案是一种可行的肝癌患者营养落实管理模式,可改善患者营养状况,促进术后患者康复。Objective To explore the effects of the implementation of the goal-directed nutrition on the nutritional status and postoperative rehabilitation of operative patients with liver cancer combined with cirrhosis from admission to discharge.Methods A cancer target nutrition team was established,a target nutrition pathway implementation list was formulated and applied throughout the whole progress of hospitalization,pre-operation,post-operation,discharge from hospital,and post-discharge.121 liver cancer patients operated before the implementation of goal-directed nutrition pathway management were included in the control group,and 126 patients operated after implementation were selected as the trial group.We evaluated the efficacy of intestinal nutrition efficacy real-timely and dynamically regulated the target nutrition in the experimental group.The changes of some data such as skeletal muscle,albumin,prealbumin on the 14th day after surgery,and the recovery time of intestinal function,postoperative complications,and the average hospital stay were compared between the two group.Results In the experimental group,there were no significant decrease in the skeletal muscle,the recovery time of intestinal function was significantly earlier,the level of albumin and prealbuminon was significantly better than that of the control group,and the incidence of bloating,diarrhea,ascites and infection was significantly lower than that of the control group.Conclusion The target nutrition management in the perioperative period delivered by the nutrition support group is a feasible nutrition implementation management mode for liver cancer patients,which can improve the nutritional status of patients and promote the rehabilitation of patients after surgery.

关 键 词：肝癌 目标营养 康复 

分 类 号：R735.7[医药卫生—肿瘤] R657.31[医药卫生—临床医学] R459.3