肝胆胰外科患者营养风险筛查与临床结局分析

目的调查肝胆胰外科住院患者营养风险及住院期间的营养支持状况,分析营养风险与临床结局的关系。方法选择我院2011年7月至2012年1月期间肝胆胰外科住院患者,入院时使用营养风险筛查工具(NRS2002)进行营养风险筛查,调查住院期间的营养风险、营养支持状况,统计患者并发症发生率及住院时间。结果共有411例住院患者入选,总营养风险发生率为20.6%,肝癌的营养风险发生率最高(59.3%),其次为胆管癌(32%),胆囊息肉营养风险发生率最低(4.4%);有营养风险的患者术后并发症的发生率明显高于无营养风险的患者(44.7%vs19.6%,P<0.001);而在严重并发症发生率方面两者无显著差异(34.2%vs32.8%,P=0.885)。有营养风险的患者中应用营养支持者并发症发生率、平均住院时间均明显下降38.1%vs63.6%,P=0.038;(15.41±2.47)dvs(17.00±3.38)d,P=0.021]。无营养风险的患者中应用营养支持者并发症发生率未见明显下降,相反却升高(21.9%vs17.5%,P=0.319),住院时间也较未用营养支持的患者延长(12.75±2.63)dvs(11.75±2.97)d,P=0.002]。结论肝胆胰外科住院患者中恶性疾病患者营养风险较高,有营养风险的患者不良并发症发生率高于无营养风险患者,给予有营养风险患者营养支持可以改善临床结局。

Nutritional risk screening and analysis of clinical outcomes in hospitalized patientswith hepatobiliary and pancreatic diseases

Objective To investigate nutritional risk and nutritional support in hospitalized patients with hepatobiliary and pancreatic diseases,and to analyze the relationship between nutritional risk and clinical outcomes.Methods In this prospective cohort study,patients with hepatobiliary and pancreatic diseases were recruited from July 2011 to January 2012.Patients were screened using Nutritional Risk Screening 2002(NRS2002) at admission.Data of the nutritional risk,application of nutritional support,complications and duration of hospitalzation were collected.Results Four hundred and eleven patients with hepatobiliary and pancreatic diseases were recruited,the overall prevalence of nutritional risk was 20.6% at admission,59.3% in liver cancer,32% in the bile duct cancer,while the lowest nutritional risk was found in liver cysts(4.4%).The rate of complications in the patients with nutritional risk was higher than that in the patients without nutritional risk(44.7% vs 19.6%,P <0.001).Serious complications in patients with nutritional risk had no significantly different with patients without nutritional risk(34.2% vs 32.8 %,P =0.885).For the patients with nutritional risk,the complications rates and the average duration of hospitalzation in patients with nutritional support were significantly lower than those without nutritional support(38.1% vs 63.6%,P =0.038;15.41 ± 2.47 d vs 17.00 ± 3.38 d,P =0.021);For the patients without nutritional risk,the complications of patients with nutritional support was significantly higher than those without nutritional suppor(t21.9% vs 17.5%,P =0.319),while the average duration of hospitalzation of patients with nutritional support was significantly longer than those without nutritional support(12.75 ±2.63 d vs 11.75 ±2.97 d,P =0.002).Conclusion Patients with hepatobiliary and pancreatic diseases have a higher nutritional risk in malignant disease,and patients with nutritional risk have more complications;nutritional support is beneficial to the patients with nutritional risk by improving clinical outcomes.