营养风险与肝硬化食管胃底静脉曲张内镜治疗术后感染增加相关  

Nutritional risk is associated with an increase of postoperative infection after endoscopic treatment for esophagogastric variceal bleeding in liver cirrhosis

作　　者：楼建军[1] 张芳芳 黄妍 桑玉尔[2] LOU Jian-jun;ZHANG Fang-fang;HUANG Yan;SANG Yuer(Yuyao People's Hospital of Zhejiang Province,Zhejiang 315400,China;Department of Gastroenterology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]浙江省余姚市人民医院,315400 [2]上海交通大学医学院附属新华医院

出　　处：《肝脏》2022年第11期1183-1188,共6页Chinese Hepatology

基　　金：2020年余姚市卫生健康科技计划项目(2020YPT09)。

摘　　要：目的探讨肝硬化食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding,EGVB)患者营养风险的患病率及营养风险与内镜治疗术后感染的关系。方法纳入经内镜下治疗的肝硬化EGVB患者163例,使用营养风险筛查表2002(nutritional risk screening 2002,NRS2002)评估营养风险。收集患者的病史、肝功能、血氨水平、Child-Pugh评分、B超和术后感染状况。结果根据NRS2002评分,163例肝硬化EGVB患者中有79例(48.5%)存在营养风险。有营养风险组患者的血清白蛋白为(27.87±3.70)g/L、前白蛋白为(0.08±0.02)g/L,低于无营养风险组的(35.76±4.32)g/L、(0.11±0.03)g/L,而血氨、凝血时间、国际标准化比率、Child-Pugh评分B/C级、腹水及内镜治疗术后感染发生比例均显著升高(均P<0.05)。这些患者内镜治疗后感染的发生率为19.0%,其中营养风险组为32.9%,无营养风险组为5.95%。通过多因素分析示,年龄≥60岁(OR:4.610,95%CI:1.028~20.673,P=0.046)、白细胞水平(OR:1.324,95%CI:1.036~1.693,P=0.025)和NRS2002≥3(OR:11.670,95%CI:1.832~74.334,P=0.009)是肝硬化EGVB患者内镜治疗术后感染的危险因素。结论存在营养风险的肝硬化EGVB患者经内镜治疗后更易发生术后感染。肝硬化EGVB患者在进行内镜治疗前后,有必要进行营养评估和一些干预措施。Objective To investigate the incidence rate of the nutritional risk on cirrhosis patients with esophagogastric variceal bleeding(EGVB).To investigate the correlation between nutritional risk and postoperative infection after endoscopic therapy.Methods A total of 163 patients with EGVB who received endoscopic therapy were involved.The nutritional risk was evaluated based the Nutrition Risk Screening Sore(NRS2002).The data including medical history,liver function,blood ammonia levels,Child-Pugh scores,B ultrasound and postoperative infection status were colledcted.Results According to the NRS2002 scores,there were 79(48.5%)patients with nutritional risk.The level of serum albumin(27.87±3.70)g/L and prealbumin values(0.08±0.02)g/L of patients with nutritional risk were significantly lower(P<0.05)than that without the nutritional risk(35.76±4.32,0.11±0.03)g/L.The blood ammonia,prothrombin time(PT),international normalized ratio(INR)and Child-Pugh B/C,ascites and postoperative infection proportion were significantly increased in patients with nutritional risk(P<0.05).The incidence of postoperative infection after endoscopic treatment was 19.0%in all patients,32.9%in patients with nutritional risk,and 6.0%in patients without nutritional risk.Age≥60(OR:4.610;95%CI:1.028-20.673;P=0.046),WBC level(OR:1.324;95%CI:1.036-1.693;P=0.025)and NRS2002≥3(OR:11.670;95%CI:1.832-74.334;P=0.009)were significant risk factors.Conclusion The patients with nutritional risk are more likely to suffer from postoperative infection after endoscopic treatment.It is neccessary for cirrhosis patients with EGVB to receive nutritional assessment as well as clinical interventions before and after the endoscopic treatment.

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 内镜治疗 营养风险 术后感染 危险因素 

分 类 号：R657.3[医药卫生—外科学]