3种营养筛查工具对腹腔镜结直肠癌切除术后并发症预测价值研究

目的 探讨适用于预测腹腔镜结直肠癌切除术后并发症的最适营养筛查工具。方法 选择2016年3月至2017年6月同济大学附属第十人医院收治的197例择期行腹腔镜结直肠癌切除术的病人临床资料。单因素及多因素Logistic回归分析探讨术后并发症的相关因素,并分析比较3种营养筛查（NRS2002、MUST、NRI）与术后并发症的关系,采用多因素分析P＜0.05的因素,构建腹腔镜结直肠癌切除术后并发症模型。结果 197例结直肠癌病人中,其中60例（30.5%）病人发生并发症。使用NRS2002、MUST、NRI评估营养风险发生率分别为32.0%、42.6%、24.4%。发生并发症组病人的住院时间（P＜0.001）及住院费用（P＜0.001）明显高于未发生并发症组。单因素分析显示,年龄≥70岁（OR=2.455,P=0.005）和NRI评分＜97.5分（OR=2.194,P=0.021）是并发症发生的危险因素。多因素分析显示,年龄≥70岁（OR=2.382,95%CI 1.228~4.620,P=0.010）、NRI评分＜97.5分（OR=2.067,95%CI 1.012~4.221,P=0.048）、手术时间≥180 min（OR=2.383,95%CI 1.149~4.939,P=0.020）是并发症发生的独立危险因素。腹腔镜结直肠癌切除术后并发症模型中,风险分数（0~3）对应的并发症发生率依次为16.5%、34.9%、48.4%、75.0%。结论 相较NRS2002和MUST,建议结直肠癌病人入院时使用NRI进行营养风险筛查,及早干预治疗。     

术前运用NRS2002评估食管癌患者营养风险及临床结局的研究

目的运用营养风险筛查2002(NRS2002)对食管癌术前患者进行营养风险筛查,了解营养风险评分结果和临床结局发生之间的关系。方法运用NRS2002方法对上海交通大学医学院附属仁济医院胸外科于2012年3月至2013年3月收治并手术的225例食管癌患者进行术前NRS2002营养风险筛查,其中男136例、女89例,年龄41~85(64.0±8.2)岁。总评分为疾病严重程度评分、营养状况评分、年龄评分(≥70岁年龄评分为1分,70岁为0分)3项的总和。临床结局设定为术后并发症发生率、死亡率和住院时间。结果术前评分≥3分者为75例(33.3%),3分者为150例(66.7%);NRS2002评分≥3分者术后并发症发生率高于NRS2002评分3分者,差异有统计学意义(26.7%vs.12.0%,P0.05);NRS2002评分≥3分者总住院时间长于NRS2002评分3者,差异有统计学意义[(29.80±7.94)d vs.(15.30±2.05)d,P0.05]。Logistic回归分析结果发现NRS2002、基础疾病、手术方式是术后并发症发生的危险因素。结论术前NRS2002评分≥3分的食管癌患者术后并发症发生率升高,住院时间延长,这提示有必要对于术前营养风险评分≥3分的食管癌患者进行适当及科学的营养干预。NRS2002可以作为评估食管癌术后营养风险发生的预测指标。     

普外科老年病人手术前后营养风险筛查及临床意义

目的 研究普通外科老年病人手术前后营养风险筛查和病人营养状况恢复情况以及与并发症的相关性.方法 对684例符合条件的普通外科老年手术病人于入院后24小时和术后进行NRS2002评分,并通过对病人手术前后血红蛋白、血清白蛋白(ALB)和前白蛋白(PA)的变化,观察病人手术前后机体营养恢复情况,记录并发症的发生率.结果 术前NRS2002评分≥3分者173例(25.3%),＜3分者511例(74.7%);术后NRS2002评分≥3分和＜3分者分别为316例(46.2%)和368例(45.7%).在术前NRS2002≥3分的病人术后并发症发生率为42%.在NRS2002＜3分的病人术后并发症发生率22.9%.存在营养风险的患者并发症的发生率显著高于不存在营养风险的患者(P＜0.05).术后血红蛋白、血清白蛋白和前白蛋白的异常发生率显著高于术前(P＜0.05).结论 普外科老年病人存在的营养风险较高,术前NRS2002≥3分的病人营养状况恢复慢,并发症的发生率升高.     

胃肠道肿瘤患者术前营养风险筛查与机体组分变化研究

目的 探讨胃肠道肿瘤患者营养风险发生情况及机体组分的改变.为营养治疗的选择提供依据.方法 选取胃肠道肿瘤患者132 例作为研究对象,多频生物电阻抗分析仪测定患者机体组分,应用营养风险筛查2002（NRS 2002）进行筛查.结果 胃癌患者NRS 2002≥3 分的发生率明显高于结直肠癌患者（P 〈 0.001）;胃癌患者肥胖度、体重指数（BMI）、体重比、脂肪相对比、脂肪含量相对比、细胞质量均低于结直肠癌患者（P 〈 0.05）;存在营养风险的患者肥胖度、BMI、体重比、脂肪含量相对比、细胞质量均低于不存在营养风险患者（P 〈 0.05）.结论 胃癌患者存在营养风险的发生率明显高于结直肠癌患者,胃癌患者更易出现脂肪的丢失.     

应用营养风险筛查2002评分系统对胃癌患者术前营养风险的评估

目的 应用营养风险筛查2002(nutritional risk screening 2002,NRS 2002)评分系统对胃癌患者的术前营养风险进行评分,并观察其在我国胃癌患者的适用性及对患者术后结果的影响.方法 对我院自2004年1月至2007年12月收治的需行手术治疗的胃癌患者314例,依照结合中国体质指数正常值的NRS 2002评分标准进行术前营养风险评分,观察其对术后并发症、死亡率及住院天数的影响.结果 本组可适用NRS 2002评分系统比例占实际总人数的93.1%.术前营养评分≥3分者125例,占胃癌患者的39.8%.术前营养评分≥3分组中的手术后并发症发生率(26.2%)高于术前营养评分＜3分组(13.8%)(P＜0.05),术前营养评分≥3分组中平均住院天数[(19±12)d]高于术前营养评分＜3分组[(14±7)d],P＜0.01.利用多元logistics回归分析,术前营养评分及胃癌临床病理分期发生术后并发症的OR值分别为0.642(P＜0.05)及1.596(P＜0.01).住院天数与NRS2002评分结果之间的相关系数为0.177(P=0.002).结论 胃癌患者术前营养评分(NRS 2002)≥3分预示在术后更易发生并发症和更长的住院时间,提示对术前营养评分(NRS 2002)≥3分的患者在术前需要加强营养支持.     

术前营养风险筛查对结直肠癌患者影响的观察

探讨术前应用NRS2002行营养风险筛查在改善结直肠癌患者预后中的作用。2012年1月—2013年10月住院的结直肠癌患者140例,随机分为对照组和筛查组各70例。对照组不进行营养风险筛查,按照既往经验决定是否给予营养支持;筛查组按照NRS2002的方法进行营养风险筛查,根据筛查结果来决定是否进行规范营养支持。对比两组患者术后并发症发生率、住院时间及费用。结果显示,与对照组相比,筛查组患者的并发症(切口感染、术后肺内感染、肠梗阻、吻合口瘘)发生率显著降低(P0.05);筛查组患者住院时间及住院费用显著小于对照组患者(P=0.015,P=0.003)。结果表明,应用术前营养风险筛查(NRS2002)结果来规范是否需要营养支持,可以显著降低结直肠癌患者术后并发症发生率,减少住院费用及缩短住院时间。     

术前营养风险评分与直肠癌前切除术后吻合口瘘的关系

目的探讨直肠癌前切除患者术前营养风险评分与术后吻合口瘘的关系。方法回顾性分析2003年1月至2012年7月间南方医科大学附属南方医院收治的641例直肠癌前切除患者的临床资料,采用营养风险筛查2002（NRS2002）进行术前营养风险评分,通过单因素x。检验和多因素Logistic回归模型来分析NRS2002评分与术后吻合口瘘发生的关系。结果全组术后吻合口瘘发生率为4．1％（26／641）,其中术前NRS2002评分大于或等于3分者与小于3分者术后吻合口瘘发生率分别为6．9％（18／259）和2．1％（8／382）,差异有统计学意义（P=0．002）。校正了年龄、吻合口距肛缘距离和临床病理分期等影响因素后证实,NRS2002评分是直肠癌前切除术后吻合口瘘的独立危险因素（OR=3．198,95％CI：1．324～7．722,P=0．010）。结论术前NRS2002营养风险评分有助于直肠癌前切除术后吻合口瘘的预测,从而为预防性造瘘的适应证选择提供科学依据。     

营养风险筛查对结直肠癌手术死亡率和并发症发生率的预测价值

Objective To evaluate the impact of nutritional status on postoperative outcomes for patients with colorectal cancer. Methods Data of 289 colorectal cancer patients from the Affiliated Hospital of Putian Medical College between January 2006 and December 2009 were collected prospectively. Nutritional status was evaluated according to Reilly Nutrition Risk Score(Reilly NRS)and Nutrition Risk Screening 2002(NRS-2002). Results The postoperative mortality was 3.5%(10/289)and the complication rate was 29.4%(82/297). Patients were stratified into those at nutrition risk (n=89) and those not at risk (n=200) according to Reilly NRS and the two groups were similar in mortality rate (5.6% vs. 2.5%, P＞0.05) and complication rate (36.1% vs. 26.5%, P＞0.05). When stratified using NRS-2002, patients at nutritional risk(n=105) had a similar mortality rate (5.7% vs.2.2%, P＞0.05) but a higher complication rate (38.4% vs. 24.4%, P＜0.05). NRS-2002 remained as an significant predictor of postoperative complications (P=0.007, OR=3.14, 95% CI: 1.63-6.29) on multivariable logistic regression analysis. Conclusion As a nutritional evaluation tool, NRS-2002 may predict postoperative comphcation for colorectal cancer.     

谷氨酰胺治疗对有营养风险肝胆手术病人临床结局影响研究

目的 观察肝胆手术病人营养风险的发生率,探讨谷氨酰胺（Glutamine,GLn）治疗对有营养风险病人临床结局的影响。方法 采用队列研究的方法,连续定点采集2011年1月至2014年12月于广州军区武汉总医院行手术治疗的肝胆外科病人资料,用NRS2002评分标准,对≥3分的病人纳入研究。共402例病人,分Gln治疗组248例和非Gln组154例,观察两组住院时间和感染性并发症发生率。结果 Gln组和非Gln组感染性并发症分别为9例、14例（P＜0.05）,住院天数分别为（11.28±7.77）d、（12.03±9.02）d（P＞0.05）。NRS评分≥5分的病人,Gln组（130例）和非Gln组（47例）病人的并发症分别为4例、6例,住院时间分别为（11.21±7.15）d、（12.73±1.26）d（P＜0.05）。多因素logistic回归分析提示,Gln治疗是感染性并发症的保护因素,而NRS评分≥5分、术前GGT升高、术前前白蛋白降低是危险因素,其OR值分别为0.76、1.19、1.25、1.39,P值均小于0.05。结论 Gln治疗能显著降低存在营养风险肝胆外科手术病人的感染并发症发生率,且NRS评分≥5分的病人尚可缩短住院时间,更能从Gln治疗中获益。     

三种术前营养评价方法对消化道恶性肿瘤患者术后并发症预测价值比较

目的比较欧洲营养风险筛查2002（NRS2002）、微型营养评价法（MNA）和主观全面评价法（SGA）3种术前营养评估方法对消化道恶性肿瘤患者术后并发症的预测价值。方法前瞻性入组2012年1月至2013年6月间南华大学附属第一医院普通外科和肿瘤外科收治的235例消化道恶性肿瘤患者,其中食管癌31例,胃癌82例,结直肠癌122例。分别采用NRS2002、MNA和SGA3种营养评价方法进行术前营养评估,分别比较这3种方法筛选出的存在营养不良（营养风险）患者与营养正常（无营养风险）患者术后并发症发生率。结果按照SGA评分,235例消化道恶性肿瘤患者术前重度营养不良、中度营养不良和无营养不良者术后并发症发生率分别为40．5％（17／42）、25．3％（22／87）和14．2％（15／106）,差异有统计学意义（P〈0．01）。按照iVINA评分,术前营养不良、潜在营养不良者和营养正常者术后并发症发生率分别为32．9％（23／70）、24．7％（18／73）和14．1％（13／92）,差异有统计学意义（P〈0．05）。按照NRS2002评分,术前存在营养风险和无营养风险者术后并发症发生率分别为27．6％（27／98）和19．7％（27／137）,差异无统计学意义（P〉0．05）。多因素逻辑回归分析证实,SGA评分和MNA评分均为术后并发症的独立预测因素（均P〈0．01）。SGA评分预测术后并发症的敏感性较MNA评分为高（90．7％比79．6％）,特异性相当（49．7％比50．8％）。结论SGA评分和MNA评分均能有效预测消化道恶性肿瘤患者术后并发症的发生情况;但相较之下,SGA的预测敏感性更高。术前制定营养支持方案时应重点参考SGA评估结果。     

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??Comparison of the three nutritional screening tools to predict complications after laparoscopic resection of colorectal cancer JI Yan-bin*, SHEN Tong-yi, MA Bing-wei, et al. *Department of Gastrointestinal Surgery, Shanghai Clinical Institution, Anhui Medical University, Shanghai 200072, China
Corresponding author: YU Zhen,E-mail??yuzhen0577@163.com
Abstract Objective To identify the most appropriated nutritional screening tool for predicting postoperative complications after laparoscopic resection of colorectal cancer. Methods The clinical data of 197 patients who underwent laparoscopic resection of colorectal cancer between March 2016 and June 2017 admitted in Shanghai Tenth People’s Hospital Affiliated to Tongji University were included prospectively. NRS2002?? MUST and NRI were used to assess nutrition risk within 24h. Univariate and multivariate analysis were performed to evaluate the risk factors for postoperative complications and to compare the three nutritional screening tools to predict the occurrence of postoperative complications. The remained variables in the final logistic regression analysis were used to build a postoperative complication risk scoring model. Results Among 197 patients?? 60 patients of them ??30.5%?? developed complications. The nutrition risk was 32.0%?? 42.6% and 24.4% according to the NRS2002?? MUST and NRI?? respectively. Patients with postoperative complications had a significantly longer postoperative hospital stay and higher cost than those without postoperative complications. In the univariate analysis?? age ≥ 70 years ??OR=2.455??P=0.005?? and NRI ??97.5??OR=2.194??P=0.021??were associated with postoperative complications. Multivariable analysis showed that age ≥ 70 years??OR=2.382??95%CI??1.228-4.620?? P=0.010????NRI ??97.5??OR=2.067??95%CI??1.012-4.221?? P=0.048???? the duration of operation ≥ 180min??OR=2.383??95%CI?? 1.149-4.939?? P=0.020??were independent risk factors for postoperative complications. The probability of complications in scores (0-3) in thepostoperative complication risk scoring model after laparoscopic colorectal cancer resection was 16.5%,34.9%,48.4%,75%,respectively. Conclusion Compared with NRS2002 and MUST, NRI is recommended to perform for nutritional risk screening and early intervention when patients with colorectal cancer are admitted.     

352例胃肠外科手术患者营养状况筛查与分析

目的：统计胃肠外科手术患者营养风险发生概况,为临床更好地应用营养支持提供循证医学证据.方法：采用定点连续抽样法,对山东省立医院胃肠外科2012年10月-2013年2月352例手术患者应用营养风险筛查2002（NRS2002）进行统计研究,观察NRS2002的适用率、营养风险发生率及支持率、营养风险及不同方式营养支持对预后的影响.结果：NRS2002的适用率为98.3％,完全适用于我科临床.整体住院患者营养风险的发生率为25.72％.无营养风险组在术后并发症发生率（14.66％ vs35.00％,P=0.018）、术后住院时间（15.25±5.37d治17.72 ±5.31 d,P=0.023）均优于存在营养风险组.通过营养支持手段,缩短了营养风险患者的住院时间（15.22±4.55 d vs 17.72±5.31 d,P=0.029）、减少了并发症的发生（16.95％vs 35.00％,P=0.043）.风险组整体与无风险组整体比较,术前白蛋白显著偏低（36.72±4.02 g/Lvs 39.37±5.31 g/L,P=0.000）,预后无明显差异（预后指标P均大于0.05）.术后及时合理应用肠内营养能缩短禁饮食时间（3.25±1.32 d vs 3.73±1.54d,P=0.027）,减少肠外营养（PN）应用时间（6.35±2.21 dvs 7.13±2.10 d,P=0.007）.术后较长时间应用PN对预后无明显影响,但显著增加住院费用（47385.32±8521.63元vs 49235±8374.52元,P=0.049）.结论：对手术患者术前进行营养风险筛查十分必要,对于存在营养风险的患者应及时进行营养支持治疗.合理地应用营养支持能有效地改善预后.     

进展期胃癌术后营养状态对化疗影响的临床观察

目的：观察进展期胃癌术后不同营养状态患者化疗期间的临床状况差异性,探讨营养治疗在营养不良患者化疗期间的临床意义。方法运用营养风险筛查（NRS2002）评价标准,选取进展期胃癌术后NRS＞3分的80例患者,随机分为实验组和对照组,每组各40例。实验组患者进行肠外营养支持,对照组除不予肠外营养支持外其余同实验组。比较两组患者的营养生化指标、化疗毒副反应。结果实验组和对照组在营养生化指标、化疗毒副反应评分差异上有统计学意义（P＜0．05）。结论营养不良状态是影响胃癌术后化疗的不利因素,降低化疗耐受力、生活质量,影响胃癌术后化疗的临床转归,营养支持治疗使营养不良患者化疗期间临床受益。     

Screening of Nutritional Risk and Nutritional Support in General Surgery Patients: A Survey from Shanghai,China

To determine the prevalence of nutritional risk in surgical departments and to evaluate the impact of nutritional support on clinical outcomes. The nutritional risk in different surgical diseases and the different way of nutritional support on clinical outcomes in patients at nutritional risk remain unclear. Hospitalized patients from general surgical departments were screened using the Nutritional Risk Screening (NRS) 2002 questionnaire on admission. Data were collected on nutritional risk, complications, and length of stay (LOS). Overall, 5034 patients were recruited; the overall prevalence of nutritional risk on admission were 19.2%. The highest prevalence was found among patients with gastric cancer. At-risk patients had more complications and longer LOS than nonrisk patients. Of the at-risk patients, the complication rate was significantly lower and LOS was significantly shorter in the nutritional-support group than in the no-support group (20.9 versus 30.0%, P < 0.05). Subgroup analysis showed reduced complication rates and LOS only in patients with gastric cancer, colorectal cancer, and hepato-pancreato-biliary (HPB) cancer. Significantly lower complication rates relative to nonsupported patients were found among patients who received enteral nutrition or who received support for 5 to 7 days, or daily support entailing 16 to 25 kcal/kg of nonprotein energy. Different surgical diseases have different levels of nutritional risk. The provision of nutritional support was associated with a lower complication rate and a shorter LOS for gastric, colorectal, and HPB cancer patients at nutritional risk. The improper use of nutritional support may not improve outcomes for at-risk patients.Key words: Nutritional risk screening 2002, Nutritional support, Surgery, Complications, Length of stayMalnutrition is a key concern to the surgeon. Nutritional depletion not only adversely affects the clinical surgical condition of a patient, but it may also increase the risk of poor postoperative outcomes.^1–3 Nutritional support has positive effects on the patients with malnutrition, while nutritional therapy may have no benefit for patients with normal nutritional status and could cause ill effects.^4,5 Therefore, it is important for surgeons to assess nutritional status before nutritional therapy is implemented.There has been a lack of a unified standard of nutrition screening for many years. In addition, most of the used screening scores have not been validated with respect to clinical outcomes, which is the most relevant question for clinicians. Kondrup et al⁶ established the Nutritional Risk Screening Tool (NRS)-2002, which has been recommended by the European Society of Parenteral and Enteral Nutrition for nutritional screening in hospitalized patients.⁷ The suitability of the NRS-2002 in China was first reported by Chen et al⁸ in a single Chinese hospital in a study that indicated 100% of general surgery patients can use this screening tool; a similar finding was then reported by Jiang et al⁹ in a national survey, which indicated that the NRS-2002 can be completed by 99.2% of hospitalized surgery patients in China.The Nutritional Risk Screening Tool is a simple tool for the evaluation of nutritional status and strongly predicts the incidence and severity of postoperative complications in surgical patients.^10,11 Further studies are needed to differentiate between the effects of nutritional risk in different surgical diseases, and the effects of nutritional support on clinical outcomes in patients at nutritional risk need to be confirmed across surgical pathologies. Therefore, we conducted this study in a large cohort of more than 5000 patients. This study design enables screenings to be made for a large number of potentially confounding variables, which adds specificity to observed associations between NRS score and clinical outcome.     

NRS-2002评估术前不同营养状态对结直肠癌患者生存质量的影响

目的探讨术前不同营养状态对结直肠癌患者生存质量的影响。方法选取2012年9月至2012年12月期间四川大学华西医院胃肠外科中心收治的结直肠癌患者,采用欧洲营养风险筛查量表（nutritionalriskscreening2002,NRS-2002）对其术前营养状态进行评分,同时运用欧洲癌症研究与治疗组织的生命质量核心量表（EORTCQLQ．C30）评估患者术后1个月的生存质量情况。结果本研究共纳入患者44例,根据术前营养状态评分分为2组：轻度营养风险组（1分）27例及中重度营养风险组（≥2分）17例。2组患者的基线资料中,中重度营养风险组患者年龄明显大于轻度营养风险组患者（P=0．001）,而性别（P=0．718）、肿瘤TNM分期（P=0．302）、分化程度（P=0．564）、术前合并症（P=0．070）、术后并发症[NS（无统计学意义）]及造口（P=0．786）方面,2组患者间的差异均无统计学意义。生存质量方面,2组患者在功能领域、症状领域、单个条目及总体健康情况方面的差异均无统计学意义（P〉0．05）。结论未能得出结直肠癌患者术前营养状态与其生存质量有关。这可能与本研究样本量较小、评估时间短且时间点单一有关,因此有待进一步的大样本、应用多种评估方式和选取多个不同时间点来更客观地评估结直肠癌患者营养状态对生存质量的影响。     

胃肠外科手术患者营养风险发生研究

目的探讨胃肠外科手术患者营养风险发生及营养支持情况。方法对我院2013年1月至2013年6月胃肠外科收治的252例胃肠外科手术患者采用NRS 2002营养风险筛查工具进行营养风险筛查,根据筛查结果研究NRS 2002营养筛查工具的适用率、胃肠外科手术患者营养风险发生率、营养支持率、营养风险及营养支持治疗对患者住院时间及并发症发生率等临床结局的影响。结果 NRS 2002营养风险筛查工具适用率为98.4%,适用于我院胃肠外科手术患者。我院胃肠外科手术患者的营养风险发生率为40.3%,其中无营养风险手术患者术后住院时间及术后并发症发生率均明显低于存在营养风险手术患者(P0.05)。通过有效的营养支持,存在营养风险的手术患者临床结局得到明显改善(P0.05),不存在营养风险的手术患者则无明显改善(P0.05)。结论 NSR2002适用于胃肠外科手术患者,对存在营养风险的患者及时进行有效的营养支持治疗可改善患者的住院时间及术后并发症等临床结局,促进患者康复。