术前营养风险筛查对结直肠癌患者围手术期营养支持治疗的临床意义

目的探讨术前营养风险筛查对结直肠癌患者围手术期营养支持的指导作用，为临床合理开展营养支持提供依据。方法参照营养风险筛查方法2002（NRS2002）。对2009年3月至2010年3月间在无锡市第四人民医院、同济大学附属同济医院及苏州大学附属第二医院住院治疗的290例结直肠癌患者进行术前营养风险评估。并根据评估结果比较术前接受与未接受营养支持患者术后肠功能恢复情况及相关营养指标。结果营养风险筛查结果显示，110例结直肠癌患者术前存在营养风险，其中65例实施了营养支持，其临床结局均明显优于未接受营养支持的45例患者术后排气时间（2．3±0．5）d比（3．3±0．5）d、排粪时间（3．5±0．5）d比（4．6±0．6）d、恢复半流饮食时间（10．1±1．2）d比（12．4±2．2）d和术后住院时间（15．7±1．1）d比（18．8±1．4）d，均P〈0．05]；其术后第7天营养指标也优于未接受营养支持者血清白蛋白（33．2±4．5）g／L比（26．0±4．0）g／L、前白蛋白（0．28±0．05）g／L比（0．16±0．04）g／L和转铁蛋白（1．92±0．33）g／L比（1．75±0．45）g／L，均P〈0．05]。但对于180例经营养风险筛查术前无营养风险患者，术前是否接受营养支持其上述临床结局及营养指标的差异均无统计学意义（均P〉0．05）。结论对于术前营养风险筛查提示存在营养风险的结直肠癌患者，术前应积极予以营养支持；但对于无营养风险者，围手术期的营养支持或并不必要。

Application of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients

Objective To investigate the guidance role of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients in order to provide evidence for the rational clinical application of nutrition support. Methods Nutritional risk screening was carried out in 290 hospitalized colorectal cancer patients from The Fourth People＇s Hospital of Wuxi City, Tongji Hospital of Tongji University and The Second Hospital of Soochow University with the nutritional risk screening（NSR） 2002 score summary table. Postoperative bowel function recovery and associated nutritional indices were compared between patients who received preoperative nutrition support according to the risk screening results and those who did not. Results Among 110 patients at nutritional risk, 65 received perioperative nutrition support and had faster recovery of intestinal function time to first flatus（2.3±0.5） d vs. （3.3± 0.5） d, time to first defecation （3.5±0.5） d vs. （4.6±0.6） d, semi-fluid intake（10.1±1.2） d vs. （12.4± 2.2） d], shorter postoperative stay （15.7±1.1）d vs. （18.8±1.4） d], and higher albumin, prealbumin and transferrin （33.2±4.5） g/L vs. （26.0±4.0） g/L, （0.28±0.05） g/L vs. （0.16±0.04） g/L, （1.92±0.33） g/L vs. （1.75±0.45） g/L] at 7-day postoperatively （all P〈0.05） as compared to those without perioperative nutrition support （n=45）. While among 180 cases without nutritional risk, there were no significant differences in the above indices between patients who received preoperative nutrition support and those who did not （all P〉0.05）. Conclusion It is important to evaluate the nutritional risk in hospitalized patients with colorectal cancer, and to carry out nutrition support actively for those at nutritional risk.