营养干预对高龄结直肠癌患者腹腔镜手术疗效的影响  

Influence of nutritional intervention on laparoscopic surgery in elderly patients with colorectal cancer

作　　者：顾颖 荣岚[1,2] 于岚[1,2] 张俊[3] 黄雷 万歆[4] 姜胜耀[4] 王蕾[5] 胡伟国[6] GU Ying;RONG Lan;YU Lan(Department of Geriatrics,Geriatric Medicine Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Nursing,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine)

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科老年医学中心,上海200025 [2]上海交通大学医学院附属瑞金医院护理部 [3]上海交通大学医学院附属瑞金医院肿瘤科 [4]上海交通大学医学院附属瑞金医院计算机中心 [5]上海交通大学医学院附属瑞金医院消化科 [6]上海交通大学医学院附属瑞金医院普通外科

出　　处：《腹腔镜外科杂志》2022年第10期748-751,共4页Journal of Laparoscopic Surgery

基　　金：上海交通大学医学院附属瑞金医院老年医学中心专项经费(GB202103)。

摘　　要：目的:探索高龄腹腔镜结直癌患者术前营养风险发生情况及术后营养支持的应用状况,为精准化临床诊疗及干预策略提供临床研究依据。方法:选取2016年1月至2020年12月收治的高龄(≥80岁)腹腔镜结直肠癌手术患者作为研究对象,分析患者一般信息、诊断信息、医嘱信息等,采用营养风险筛查2002(NRS2002)评估患者营养风险,分析不同程度营养风险患者、术后营养支持方式对短期临床结局(包括住院总时间、术后住院时间及住院总费用)的影响。结果:共纳入387例患者,均存在不同程度的营养风险,其中一般营养风险(3分≤NRS2002<5分)194例(50.13%),严重营养风险(NRS2002≥5分)193例(49.87%)。患者均于术后接受营养支持治疗,其中单独肠外营养(PN)支持率48.32%,PN联合肠内营养(EN)支持率51.68%。一般营养风险组中,PN亚组术后住院时间[(12.12±2.72)d vs.(7.80±1.35)d]、住院总时间[(18.40±8.28)d vs.(12.12±2.72)d]长于PN+EN亚组,住院总费用[(5.22±1.73)万元vs.(4.07±0.99)万元]高于PN+EN亚组,差异有统计学意义。严重营养风险组中,PN亚组术后住院时间[(14.98±8.96)d vs.(8.50±2.31)d]、住院总时间[(20.84±9.29)d vs.(13.26±3.89)d]长于PN+EN亚组,住院总费用[(6.16±3.14)万元vs.(4.37±1.05)万元]高于PN+EN亚组,差异均有统计学意义。结论:高龄结直肠癌手术患者营养风险发生率较高,且合并严重营养风险患者占比较高。虽然腹腔镜手术可减少创伤,但患者营养状况也会严重影响预后与康复。针对高龄手术患者开展营养风险评估与干预、积极落实规范合理的营养支持治疗,有助于改善其短期临床结局。Objective:To explore the occurrence of preoperative nutritional risk and the application of postoperative nutritional support in elderly patients with colorectal cancer,so as to provide research basis for accurate clinical diagnosis and interventions.M ethods:The data of this study came from the information management system of a class A tertiary hospital in Shanghai.The patients were hospitalized from Jan.2016 to Dec.2020.The elderly patients(≥80 years old)with colorectal cancer were selected as the r esearch object to make a descriptive analysis of the general information,diagnostic information and medical order information of the p atients.Nutritional risk screening(NRS)2002 was used to evaluate the nutritional risk of patients,and the influences of patients with different degrees of nutritional risk and postoperative nutritional support on short-term clinical outcomes(including total hospital stay,postoperative hospital stay and total cost of hospitalization)were analyzed.Results:A total of 387 elderly patients with colorectal cancer who met the inclusion and exclusion criteria were collected in this study.All of them had varying degrees of nutritional risk,including 194 patients(50.13%)with 3≤NRS2002<5 and 193 patients(49.87%)with NRS2002≥5 points.All patients received nutritional support treatment after operation,the support rate of parenteral nutrition(PN)was 48.32%,and the support rate of PN+enteral nutrition(EN)was 51.68%.In the general nutrition risk group,the postoperative hospital stay[(12.12±2.72)d vs.(7.80±1.35)d],t otal hospitalization time[(18.40±8.28)d vs.(12.12±2.72)d]and total cost of hospitalization[(5.22±1.73)ten thousand yuan vs.(4.07±0.99)ten thousand yuan]in PN group were more than those in PN+EN group.In the severe nutrition risk group,the postoperative hospital stay[(14.98±8.96)d vs.(8.50±2.31)d],total hospitalization time[(20.84±9.29)d vs.(13.26±3.89)d]and total cost of hospitalization[(6.16±3.14)ten thousand yuan vs.(4.37±1.05)ten thousand yuan]in PN group were more t

关 键 词：结直肠肿瘤 腹腔镜检查 营养风险筛查 老年人 

分 类 号：R735.34[医药卫生—肿瘤]