作者：赵静1，李金花1，吴昊1，王林俊2，尹悦3

单位：1.南京医科大学第一附属医院 老年肿瘤科， 江苏 南京 210029； 2.南京医科大学第一附属医院 胃肠外科， 江苏 南京 210029； 3.南京医科大学第一附属医院 肿瘤科， 江苏 南京 210029

Authors: Zhao Jing1， Li Jinhua1， Wu Hao1， Wang Linjun2， Yin Yue3

Unit: 1.Department of Geriatric Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China； 2.Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China； 3.Department of Oncology, The First Affiliated Hospital of Nanjing Medical, Nanjing 210029, Jiangsu, China

摘要：

目的 观察全程营养管理对胃癌患者围手术期营养状况、术后并发症以及出院后生活质量的影响。方法 纳入胃癌患者322例,随机分为对照组(167例)与研究组(155)。两组术前均采用患者参与的主观全面评定(patient-generated subjective global assessment, PG-SGA)和营养风险筛查2002(nutritional risk screening 2002, NRS 2002)进行营养风险筛查和评估,对照组采用常规营养方案,研究组采用全程营养管理方案。对两组术后营养指标、胃肠道恢复情况、术后并发症以及出院后生活质量进行比较。结果 NRS 2002营养风险筛查结果显示76.40%的患者存在营养风险。根据PG-SGA显示,35.40%患者存在轻/中度营养不良,45.03%处于严重营养不良状态。研究组术后6 d总蛋白(65.42±8.13) g/L高于对照组(54.97±7.59) g/L (P<0.05),术后6 d白蛋白(40.23±5.61) g/L高于对照组(35.12±4.98) g/L (P<0.05),出院当天体质量指数(24.73±6.21) kg/m2高于对照组(21.28±3.05)kg/m2(P<0.05)。术后研究组胃肠道不良反应发生率(5.16%),术后肛门排气时间(3.14±1.23) d,术后并发症发生率均低于对照组(P<0.05)。研究组的住院费用(66 230.34±11 652.12)元低于对照组(87 812.29±28 651.35)元(P<0.05)。出院后研究组生活质量评分高于对照组(P<0.05)。结论 全程营养管理能改善胃癌患者术后的营养状况,促进消化道功能恢复,降低术后并发症发生率,增强机体免疫力,减少住院费用,提高胃癌患者术后的生活质量。

关键词：胃癌; 营养不良; 营养干预; 预后

Abstract：

Objective To observe the effect of whole-course nutritional management on the nutritional status, postoperative complications, and quality of life of patients with gastric cancer during perioperative period. Methods 322 patients with gastric cancer were randomly divided into control group （167 cases） and study group （155 cases）. PG-SGA and NRS 2002 were used for nutritional risk screening and assessment before operation in the two groups. The control group was treated with routine nutritional scheme, and the study group was treated with whole-course nutritional management scheme. The postoperative nutritional indicators, gastrointestinal recovery, postoperative complications and quality of life after discharge were compared between the two groups. Results NRS 2002 nutritional risk screening results showed that 76.40% of patients had nutritional risk. According to PG -SGA nutritional assessment, 35.40% of patients had mild/moderate malnutrition and 45.03% were in severe malnutrition. The total protein （65.42 ± 8.13） g/L in the study group was higher than that in the control group （54.97±7.59） g/L （P<0.05）, the albumin （40.23±5.61） g/L was higher than that in the control group （35.12±4.98 ） g/L （P<0.05 ）, and the body mass index （24.73 ± 6.21） kg/m2 was higher than that in the control group （21.28 ±3.05） kg/m2 （P <0.05）. The incidence of gastrointestinal adverse reactions （5.16%）, postoperative anal exhaust time （3.14±1.23） d and postoperative complications in the study group were lower than those in the control group （P<0.05）. The hospitalization cost of the study group （66 230.34±11 652.12） yuan was lower than that of the control group （87 812.29 ± 28 651.35） yuan （P<0.05）. After discharge, the score of quality of life in the study group was higher than that in the control group （P<0.05）. Conclusion The application of whole process nutrition management in perioperative and discharge follow-up of patients with gastric cancer can improve the nutritional status of patients after operation, promote the recovery of gastrointestinal function, reduce the incidence of postoperative complications, enhance immunity, reduce hospitalization expenses, and improve the quality of life of patients with gastric cancer after operation.

Key Words: Gastric cancer; Innutrition; Nutrition intervention; Prognosis