消化系统恶性肿瘤病人围手术期营养支持现况调查

目的:调查我院消化系统恶性肿瘤大手术病人营养支持现状和存在问题,为进一步规范肿瘤病人的临床营养支持工作提供依据。方法:回顾性调查我院肿瘤外科2010年1个月内出院的消化系统恶性肿瘤大手术病人病历180份,对其围手术期营养支持情况进行分析。结果:肠外营养(PN)与肠内营养支持(EN)人数比为3.2∶1。手术前后营养支持率分别为5.2%和100%。围手术期营养支持平均天数为(12.1±8.3)天,术后营养支持中位天数分别为胰腺癌13.3 d,食管贲门癌13.2 d,胃癌8.0 d,肝胆癌5.4 d,结直肠癌5.1 d。术后营养支持人均供给热量为5 633.3～693.7 kJ(1 346.4±165.8kcal)/d,其中每公斤理想体重平均供给热量104.6～125.5kJ(25～30 kcal)/(kg.d)的人数占32.8%,<83.68 kJ(20 kcal)/(kg.d)的人数占28.4%,<62.76 kJ(15 kcal)/(kg.d)的人数占7.8%。此外,PN病人中92.7%人次使用了谷氨酰胺、鱼油免疫营养支持治疗,EN病人中14.8%人次使用了富含鱼油的EN制剂。营养制剂费用人均(7 024.4±7 330.2)元人民币,日均(611.6±473.5)元人民币,日均营养制剂费用PN组显著高于EN组(P<0.01)。结论:我院肿瘤外科病人的营养支持已得到普遍重视。然而,围手术期营养支持不尽合理,不足和过度并存,仍需继续推广基于证据的肠外肠内营养指南。

A survey of perioperative nutritional support in digestive system cancer patients

Objective: To learn the current status of perioperative nutritional support in digestive system cancer patients.Methods: A retrospect survey was done in the digestive system cancer major operation patients who discharged from our hospital during one month in 2010.The rationality of perioperative nutritional support was analyzed.Results: 180 of patients were eligible.The proportion of parental nutrition(PN) and enteral nutrition(EN) was 3.2 ∶ 1.Totally 5.2% of patients received preoperative nutritional support,and 100% patients received postoperative nutritional support.The average duration of perioperative nutrition support was(12.1±8.3) days,and median duration of postperative nutrition support was 13.3 days in pancreas,13.2 days in oesophagus and cardia carcinoma patients,8.0 days in gastric carcinoma patients,5.4 days in liver carcinoma patients,5.1 days in colon and rectum carcinoma patients.The average energy supply by postoperative nutritional support was 5 633.3～693.7 kJ(1346.4±165.8 kcal)/d,32.8% of patients was feed 104.6 kJ～125.5 kJ(25～30 kcal)/(kg·d) and 28.4% of patients was feed <83.68 kJ(20 kcal)/(kg·d),7.8% of patients was feed <62.76 kJ(15 kcal)/(kg·d).Furthermore,92.7% of patients with PN received intravenous immunonutrition supplementation,such as glutamine and fish oil,and 14.8% of patients with EN received a formula enriched with ω-3 fatty acids.The cost of nutrition remedy was RMB$(7024.4±7330.2) per head and RMB$(611.6±473.5) per day,the daily average cost of nutritional remedy was higher in the PN group(RMB $749.1±477.3) than in EN group(RMB $ 218.0±100.4)(P<0.01).Conclusion: The perioperative nutritional support to digestive system cancer patients has been generally recognized.The application of nutritional support is inappropriate in some patients,underfeeding and overfeeding.It’s necessary to reinforce the dissemination of evidence-based guideline.