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.

Screening and analysis of nutritional risk in 352 cases of gastrointestinal neoplasm patients

Objective：To summarize the occurrence of nutritional risk in gastrointestinal neoplasm patients,and to propose better clinical strategies on the evidences of evidence-based medicine.Methods：The statistical study was carried out on the data of 352 cases of surgery patients in the gi-surgical depart-ment of Shandong Provincial Hospital from Oct.2012 to Feb.2013.Nutritional risk screening 2002 （NRS2002） was applied for the nutritional risk screening at admission.Several comparisons were performed to analysis the impact on prognosis from different incidence rate of nutritional risk,different nutritional support rate and different ways to get supported.Results：The NRS2002,whose applicable rate was 98.3％,was completely suitable for clinical application and the incidence of nutritional risk of overall hospital patients was 25.72％.The ＂non-risk＂ patients who did not receive preoperative nutritional support had a lower rate of postoperative complications（14.66％ vs 35.00％,P=0.018）and less postoperative hospital stay（15.25 ± 5.37 d vs 17.72 ± 5.31 d,P=0.023） than the ones with nutritional risk.Both of the rate of postoperative complications （16.95％ vs 35.00％,P=0.043） and postoperative hospital stay （15.22 ±4.55 d vs 17.72 ±5.31 d,P=0.029） of the patients in the nutritional risk group are shortened through nutritional support.The patients in nutritional risk group had a lower level of preoperative ALB （36.72 ± 4.02 g/L vs 39.37 ± 5.31 g/L,P=0.000） than the ones with no nutritional risk,but there was no significance difference in prognosis （P＞0.05）between the two groups.Applying the enteral nutrition after operations in time could shorten the days of postoperative fasting （3.25 ± 1.32 d vs 3.73 ± 1.54 d,P=0.027） and parenteral nutrition using （6.35 ± 2.21 d vs 7.13 ± 2.10 d,P=0.007）.Prolonging the time of using postoperative PN received no significant improvements in prognosis,but larger cost of hospitalization （47385.32 ± 8521.63 Yuan vs 49235 ± 8374.52 Yuan,P=0.049）.Conclusion：It is necessary to apply preoperative nutritional risk screening in surgery patients,and the patients with nutritional risk should promptly get nutrition support treatment.Rational application of nutritional support can improve the prognosis effectively.