围手术期营养支持对外科病人预后的影响

目的:分析围手术期营养支持与术后并发症和死亡率的关系。方法:采用多项营养评价指标测定4642例外科非急诊住院病人的营养状况,按是否接受围手术期营养支持分组,分析营养状况及术后死亡率和并发症的影响。结果:就各项指标分别进行营养评价,得出我院普外科非急诊病人营养不良的发生率分别是:体重指数(BMI)21.0%,三头肌皮褶厚度(TSF)50.2%,上臂围(AC)20.3%,上臂肌围(AMC)21.4%,血清白蛋白(ALB)24.5%,前白蛋白(PA)35.3%,总淋巴细胞(TLC)55.5%,主观全面评价法(SGA)38.4%。823例(17.7%)属接受正规围手术期营养支持组,3819例(82.3%)病人属未接受围手术期营养支持组。两组间的并发症发生率及死亡率相比,不存在统计学差异(14.3%比11.3%,P=0.062;2.4%比2.1%,P=0.126)。而若以两组中呈中、重度营养不良者作比较,则围手术期非营养支持组病人的并发症发生率及死亡率却明显高于接受营养支持组者(25.4%比14.5%,P=0.003;5.4%比2.8%,P=0.014),且住院时间也明显延长(24.2d比17.6d,P=0.042)。结论:围手术期营养支持对营养状况良好病人的预后无影响,但能降低呈中、重度营养不良病人的术后死亡率和并发症发生率,并缩短其住院时间。

The effect of perioperative nutritional support on outcome of surgical patients

Objective To estimate the effect of perioperative nutritional support on the outcome of surgical patients. Methods A total of 4 642 patients admitted to surgery were evaluated by a group of nutrition indexes within 48 hours. The patients were then assigned to receive or not periopreative nutritional support; operative morbidity and incidence of post-operative complications were recorded and compared between the two groups. Results The malnutrition rate of all the patients studied according to body mass index(BML), triceps skin-flod(TSF), mid-arm circumference(AC), arm muscle circumference(AMC), albumin, prealbumin, lymphocyte counts and subjective global assessement(SGA) was found to be 21.0%,50.2%,20.3%,21.4%,24.5%,35.3%,55.5% and 38.4%, respectively. Eight hundred and twenty-three patients(17.7%)received peri-opreative nutritional support for a minimum of 7 days, and 3819 patients(82.3%)received no periopreative nutritional support. There was no difference in morbidity and incidence of complications between the two groups (14.3% vs 11.3%,P=0.062;2.43% vs 2.12%, P=0.126). However, statisical differences did exist in morbidity and in post-operative complications between those with moderate or severe malnutrition receiving or not the pervoperative nutritional support.(14.50% vs 25.38%,P=0.003;2.75% vs 5.42%, P=0.014). Conclusions Perioperative nutritional support is beneficial for the moderately or severely malnourished patients, reducing the incidence of post-operative complications and the overall mortality.