原发性肝癌手术前后营养风险筛查及临床分析

目的 探讨原发性肝癌患者手术前后营养风险筛查及联合肠内、肠外营养模式对临床结局的影响.方法 参照NRS 2002工具标准,36例患者住院后第1天进行营养风险筛查,评分≥3分给予营养支持,术前术后进行肠外肠内营养支持（研究组）.30例患者术前不进行任何营养评价,术后全部接受肠外肠内营养支持（对照组）,比较两组患者术后肝功能、凝血功能、白细胞计数、中性粒细胞比率及C反应蛋白指标的变化,同时记录患者术后SIRS发生情况、感染性并发症的发生率及术后住院时间、住院费用.结果 研究组患者术后第7天血清谷丙转氨酶（AST）及C反应蛋白明显低于对照组（P＜0.05）,其余指标差异均无统计学意义（P＞0.05）.研究组患者术后SIRS发生率、术后感染性并发症发生率及术后住院时间、住院费用明显低于对照组（P＜0.05）.结论 对于肝癌手术患者,入院时应进行营养风险筛查,有营养风险者,术前、术后联合营养支持有益于改善术后营养状况和缩短住院时间,减少医疗费用,改善临床结局.

Pre-and post-operative nutritional risk screening and clinical analysis in patients with hepatocellular carcinoma

Objective To explore the effects of pre-and post-operative nutritional risk screening （NRS）and nutrition support on clinical outcomes in patients with hepatocellular carcinoma. Methyls According to the NRS 2002 standard, the NRS scoring was performed at the first day of hospitalization. Nu- tritional risk was defined as NRS 2002 scores ~〉3. Patients with nutritional risk received enteral nutrition （EN） and parenteral nutrition（PN） support preoperatively and postoperatively. The control group received EN and PN support after operation without NRS. Liver function, blood coagulation function,white blood cell counts ,percentage of neutrophils and levels of serum C-reactive protein（CRP） were detected and compared between the groups. The incidence of systemic inflammatory response syndrome（SIRS） ,infectious compli- cation,hospital stay and total medical cost were measured after operation. Results On the 7th day after operation, the serum levels of aspartate trransaminase（AST） and CRP in the study group were significantly lower than those in the control group （P 〈 0.05 ）. Those other indictions were not significantly different be- tween two groups（ P 〉0.05 ）. The incidence of SIRS and infectious complication, hospital stay and total medical cost in the study group was significantly lower than that in the control group（P 〈 0.05 ）. Conclu- sion For patients with hepatocellular carcinoma, it is important to evaluate the nutritional risk in time. Preoperative and postoperative nutrition support can improve the nutritional status and shorten the bospital stay in patients with nutritional risk, which may reduce medical cost and improve clinical outcomes.