结直肠癌加速康复外科中的营养风险筛查和营养治疗研究

目的 探讨加速康复外科中，营养风险筛查2002在结直肠癌患者围术期营养变化中的评估作用，并观察其临床应用效果及对此类患者营养治疗的指导意义。方法 根据定点连续抽样法选取2018年4月至2019年4月新入院、未经放化疗处理的围术期结直肠癌患者189例，入院24h和出院24h内均完成营养风险筛查2002。记录患者临床资料、进行人体物理指标测量和血红蛋白、血清白蛋白、前白蛋白的实验室检查，记录患者在住院期间营养治疗的应用状况，根据营养风险筛查 2002结果比较术前行与未行营养治疗患者及相关营养指标、术后康复情况。结果 所有患者全部完成营养风险筛查2002评估，动态营养风险筛查工具适用率高达100.00%。营养风险筛查结果显示，189例结直肠癌患者中，92例（48.68%）术前存在营养风险，其中30例术前给予营养治疗的患者术后康复情况优于术前未接受营养治疗的62例患者。本次研究患者术后营养治疗率为100%，其中肠内营养治疗应用比例较高。入院时营养筛查评分≥3分无营养治疗患者和入院时营养风险筛查 2002评分<3分患者在出院时的白蛋白、前白蛋白水平明显低于入院时。结论 术前营养风险筛查提示结直肠肿瘤患者入院时营养风险发生率较高，术前接受营养治疗可在一定程度上对术后康复有益，围术期过程中应及时合理予以营养治疗，改善患者预后。出院时患者营养风险有增加趋向，应重视患者出院时的营养风险筛查和评估。

Dynamic investigation of nutritional risk and nutritional support in enhanced recovery after surgery of colorectal cancer

Objective To assess the changes of perioperative nutritional risk and clinical applicability by dynamic Nutritional Risk Screening(NRS 2002),and to observe the conditions of nutrition support so as to the explore the role of dynamic NRS 2002 in guidance of perioperative nutritional support.Methods A total of 189 perioperative colorectal cancer patients without chemoradiotherapy on admission from April 2018 to April 2019 were selected by fixed place of continuous sampling.Dynamic nutritional risk screening was performed by NRS 2002 for patients at 24h after admission and within 24h after discharge.Clinical data,measurement of human physical indicators and indicators of laboratory examinations such as hemoglobin,serum albumin and prealbumin were recorded.Meanwhile,the condition of nutritional support of patients during hospital stay was recorded,related nutritional indicators and postoperative rehabilitation of patients with or without preoperative nutritional support were compared according to the screening results.Results All the 189 colorectal cancer patients enrolled in the study completed the NRS 2002 assessment,with an applicability rate of 100.00%.Nutritional risk screening results showed that there were 92 colorectal cancer patients(48.68%)with preoperative nutrition risk,among whom 30 patients(32.61%)received preoperative nutrition support,and their rehabilitation conditions were better than 62 patients without preoperative nutrition support.The postoperative nutrition support rate of the patients in the study was 100%.However,the proportion of patients with enteral nutrition support accounted for the highest,and their levels of albumin,prealbumin and hemoglobin at discharge were significantly lower when compared to the results of admission.Conclusions Preoperative nutritional risk screening indicates that patients with colorectal cancer have a higher incidence of nutritional risk for admission.Therefore,preoperative nutrition support is favorable for the rehabilitation of patients,perioperative nutrition support can improve their prognosis.Besides,nutritional risk screening and assessment at discharge are of great significance due to the increased trend of nutritional risk.