老年胃癌患者营养风险筛查及术后早期肠内营养治疗的研究

目的 了解老年胃癌患者营养状况,为营养治疗提供依据,观察早期肠内营养支持对老年胃癌术后患者的治疗意义.方法 选取2011年10月～ 2013年10月期间温州医科大学附属第一医院收治52例老年胃癌患者作为研究对象,应用营养风险筛查2002（NRS2002）进行营养风险评分,NRS2002评分为3分以下的10例患者未进行营养支持治疗（no nutrition,NN）.采用数字表法将存在营养风险的42例老年胃癌术后患者随机分为早期肠内营养（early enteral nutrition,EN）组和肠外营养（parental nutrition,PN）组,EN组2O例术中置鼻肠管,给予早期肠内营养治疗,PN组22例给予肠外营养治疗,观察并比较两组患者术后肠道功能恢复时间、住院时间和费用;测定两组患者术前和术后1周白蛋白（Alb）、前白蛋白（PA）营养指标以及血CD3％、CD4％、CD8％、CD4/CD8免疫指标并比较.结果 NRS2002评分结果显示,总评分在3分以上者在老年胃癌患者中所占比例为80.8％ （42/52）;EN组肠道功能恢复时间为2.5 ±0.6天,平均住院天数17.1 ±3.5天,均低于PN组（P＜0.05）,住院费用3.3±0.6万元,显著低于PN组（P＜0.01）;治疗1周后EN组血前白蛋白由116.2±11.7mg/L升高为289.5±18.6mg/L（P＜0.01）,比较PN组上升差异有统计学意义（P＜0.01）;EN组治疗1周后CD3％、CD4％、CD4/CD8较治疗前均升高（P＜0.01）,治疗后同PN组相比,CD4％、CD4/CD8上升更明显（P＜0.01）,而CD8％下降差异有统计学意义（P＜0.05）.NN组在治疗1周后白蛋白及前白蛋白较术前无明显变化（P＞0.05）.结论 NRS2002评分指导老年胃癌患者营养治疗方面具有一定的有效性.老年胃癌患者营养风险概率较高,术后早期EN能更好地加强老年胃癌患者营养状况,促进肠道功能恢复,改善免疫功能,缩短住院时间,减少医疗费用,值得临床应用.

Research on the Nutritional Risk in Elderly Patients with Gastric Cancer and Early Enteral Nutrition Support in the Postoperative Elderly Gastric Cancer

Objective To investigate the nutrition status and the effects of early enteral nutrition on postoperative elderly gastric cancer patients.Methods Totally 52 patients with elderly gastric cancer from Octobor 2010 to Octobor 2013 for treatment in our hospital were chosen as the research object.Nutrition Risk Screening 2002 （NRS2002） was applied to nutritional risk score.The patients whose NRS2002 score less than 3 were given no nutrition（NN,10 cases）.The patients whose NRS2002 score more than 3 were randomly divided into the early enteral nutrition（EN,20 cases）and the parental nutrition（PN,22 cases）.The hospitalization cost,length of stay and recovery time of intestinal function were observed.The levels of albumin（Alb）,pre-albumin （PA）,the percentage of CD3,CD4,CD8,CD4/CD8 ratio and IgG,IgA,IgM were detected and compared.Results NRS2002 score more than 3 in the proportion of elderly patients with gastric cancer was 80.8％ （42/52）.The recovery time of intestinal function in EN group was 2.5 ± 0.6 days,the length of stay was 24 ± 4 days,which were shorter than those in the PN group（P ＜0.05）.The hospitalization cost in EN group was 5.5 ± 0.7 thousands yuan,which was obviously shorter than that in the PN group（P ＜ 0.01）.The level of plasma pre-albumin in EN after one-week therapy was higher than before（116.2 ± 11.7mg/L vs 289.5 ± 18.6mg/L,P ＜ 0.01）,which was also higher than that in PN group（P ＜ 0.01）.After one-week treatment in EN group,the percentage of CD4 and CD4/CD8 were increased,while the percentage of CD8 was decreased,which were all of significant differences with those in PN group（P ＜ 0.01）.Besides,CD4/CD8 after one-week treatment in EN group was significantly higher than that in PN group（P ＜ 0.05）.But after one-week therapy there was no difference in the level of plasma pre-albumin in NN （P ＞ 0.05）.Conclusion NRS 2002 is validity for elderly gastric cancer patients＇ nutritional therapy.The probability of the presence of nutritional