GLIM标准下胃肠道恶性肿瘤手术患者营养状况调查及发生营养不良的影响因素分析  

Investigation of nutritional status of patients undergoing surgery for gastrointestinal malignancies under GLIM standard and analysis of influencing factors of malnutrition

作　　者：王家成 孙琳 张献娜 宗璐 顾凯利 王娟[3] 胡磊[3] 任春霞 WANG Jiacheng;SUN Lin;ZHANG Xianna;ZONG Lu;GU KaiLi;WANG Juan;HU Lei;REN Chunxia(School of Nursing,Anhui Medical University,Anhui Hefei 230022,China;The First Affiliated Hospital of Anhui Medical University,Anhui Hefei 230022,China;Department of General Surgery,the First Affiliated Hospital of USTC(Anhui Provincial Hospital),Anhui Hefei 230001,China;Department of Pancreatic Surgery,Union Hospital,Tongji Medical College Huazhong University of Science and Technology,Hubei Wuhan 430022,China)

机构地区：[1]安徽医科大学护理学院,安徽合肥230022 [2]安徽医科大学第一附属医院,安徽合肥230022 [3]中国科学技术大学附属第一医院(安徽省立医院)普外科,安徽合肥230001 [4]华中科技大学同济医学院附属协和医院胰腺外科,湖北武汉430022

出　　处：《现代肿瘤医学》2023年第17期3216-3221,共6页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81802329)。

摘　　要：目的:调查胃肠道恶性肿瘤手术患者营养状况,并探讨其影响因素。方法:横断面调查2021年01月至2022年05月入住合肥市某三级甲等医院胃肠外科560例行胃肠道恶性肿瘤根治术患者的相关资料,应用GLIM标准诊断营养不良,统计营养不良发生现况并分析其影响因素。结果:560例行胃肠道恶性肿瘤根治术患者中,营养不良的发生率为28.93%(162/560),其中重度营养不良的发生率为7.68%(43/560)。胃癌患者营养不良发生率为39.09%(95/243),结直肠癌患者营养不良发生率为21.14%(67/317)。Logistic回归分析显示:肿瘤类型(OR=3.192)、肿瘤分期、饮食教育(OR=2.821)、体质量指数(body mass index,BMI)(OR=0.709)、血清白蛋白浓度(OR=0.491)、血红蛋白浓度(OR=0.190)是胃肠道恶性肿瘤手术患者发生营养不良的影响因素(P<0.05)。结论:胃肠道恶性肿瘤手术患者易发生营养不良,且胃癌患者高于结直肠癌患者。肿瘤分期越晚及未接受正规饮食教育的患者营养不良发生率更高。入院BMI、血清白蛋白浓度、血红蛋白浓度下降是胃肠道恶性肿瘤手术患者发生营养不良的危险因素。建议临床医护人员应关注胃癌、晚期肿瘤、低蛋白血症及贫血的手术患者,及时给予个案化营养干预提高术前营养状况,改善临床结局。Objective:To investigate the nutritional status of patients undergoing surgery for gastrointestinal malignancies by GLIM standard and its influencing factors.Methods:Using the method of cross-sectional investigation,we investigated the relevant data of 560 patients admitted to the gastrointestinal surgery department of a Grade-III hospital in Hefei City from January 2021 to May 2022 who underwent radical resection of gastrointestinal malignancies.Results:The results showed that the incidence of malnutrition was 28.93%(162/560)in 560 patients who underwent radical resection of gastrointestinal malignancies,and the incidence of severe malnutrition was 7.68%(43/560).The incidence of malnutrition in gastric cancer patients was 39.09%(95/243),and the incidence of malnutrition in colorectal cancer patients was 21.14%(67/317).Logistic regression analysis showed that tumor type(OR=3.192),tumor stage,diet education(OR=2.821),body mass index(BMI)(OR=0.709),serum albumin concentration(OR=0.491),and hemoglobin concentration(OR=0.190)were influencing factors for malnutrition in patients undergoing surgery for gastrointestinal malignancies(P<0.05).Conclusion:Therefore,patients undergoing surgery for gastrointestinal malignancies are more prone to malnutrition,and the incidence of gastric cancer is higher than that of colorectal cancer.Patients with poorly differentiated tumors and no formal dietary education had a higher incidence of malnutrition.Decreased BMI and serum albumin and hemoglobin concentrations on admission are risk factors for malnutrition in patients undergoing surgery for gastrointestinal malignancies.It is suggested that clinical medical staff should pay attention to surgical patients with gastric cancer,low tumor differentiation,hypoproteinemia,andanemia,and provide timely individualized nutritional intervention to improve preoperative nutritional status and clinical outcome.

关 键 词：胃肠道恶性肿瘤 营养不良 横断面研究 GLIM标准 影响因素分析 

分 类 号：R735.2[医药卫生—肿瘤]