基于GLIM标准诊断营养不良的老年病人腹部手术后肠内、肠外营养支持的比较研究  

Comparative study of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria

作　　者：蔡卓玮 朱登峰 陈明干 蔡一亭 陈大伟 高铭 CAI Zhuowei;ZHU Dengfeng;CHEN Minggan;CAI Yiting;CHEN Dawei;GAO Ming(Department of General Surgery,Chongming Hospital,Shanghai University of Medicine and Health Sciences,Shanghai 202150,China)

机构地区：[1]上海健康医学院附属崇明医院普外科,上海202150

出　　处：《外科理论与实践》2024年第6期503-509,共7页Journal of Surgery Concepts & Practice

摘　　要：目的:观察经GLIM标准诊断为营养不良的老年腹部手术后病人采取肠内与肠外营养支持方式在术后并发症、肛门排气时间、免疫功能、疲劳指数等的影响。方法:先用全球营养领导层营养不良倡议(GLIM)两步骤诊断90例老年(≥70岁)腹部手术病人为营养不良;术后随机分为肠内营养(EN)组和肠外营养(PN)组。术后第1及第7天检测相应的免疫和疲劳指数,观察术后并发症、肛门排气时间及平均住院时间,且予以比较和分析。结果:老年腹部手术病人的营养风险发生率为61.0%(122/200),营养不良发生率为45.0%(90/200)。术后第7天EN组IgA、IgM、IgG以及CD3、CD4和CD4/CD8的含量较PN组显著增多(P<0.05)。术后EN组较PN组发生术后并发症显著减少(P<0.05),肛门排气时间及住院时间显著缩短(P<0.05)。EN组术后第7天疲劳指数计分明显优于PN组(P<0.05)。结论:基于GLIM对老年病人营养不良的诊断是进行营养干预的必要前提。早期运用EN,可减少老年病人术后并发症发生和住院时间,改善术后疲劳综合征和免疫状态,改善营养不良病人术后康复。Objective To observe the effects of postoperative complications,anal exhaust time,immune function and fatigue index of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria.Methods Ninty elderly abdominal surgery patients(more than 70 years old)who diagnosed as malnutrition by GLIM 2‐step method were divided into enteral nutrition(EN)group and parenteral nutrition(PN)group randomly.The corresponding immune and fatigue indexes were tested on day 1 and day 7 of postoperation.Postoperative complications,anal exhaust time and mean time of hospitalization were observed and analyzed.Results The incidence of malnutritional risk was 61.0%(122/200)in elderly abdominal surgery patients and malnutrition incidence was 45.0%(90/200).IgA,IgM,IgG,CD3,CD4 and CD4/CD8 on postoperative day 7 increased significantly in EN group than those in PN group(P<0.05).The postoperative complications in EN group significantly lower than that in PN group(P<0.05).Anus exhaust time and hospitalization days of EN group were shorter than that of PN group(P<0.05).Fatigue index on postoperative day 7 of EN group was significantly better than that of PN group(P<0.05).Conclusions The malnutrition diagnosis of elderly patients based on GLIM crteria is a necessary prerequisite for nutritional intervention.Early EN support can reduce postoperative complications and hospitalization days in elderly patients,improve postoperative fatigue syndrome and immune status,and improve the patients with malnutrition recover from surgery.

关 键 词：营养支持 营养不良 老年腹部手术病人 全球营养领导层营养不良倡议 

分 类 号：R656[医药卫生—外科学] R459.3[医药卫生—临床医学]