肿瘤重症患者的营养状况评估及营养支持现状分析

目的分析肿瘤重症患者的营养状况及其营养支持特点。方法回顾分析184例收治于中山大学肿瘤防治中心重症医学科（ICU）且人住时间在5d以上的肿瘤重症患者的临床资料，应用营养风险筛查2002（NRS2002）对患者入院时营养状况进行评估，分析入院时营养状况和营养支持情况对入住ICU时间、机械通气情况以及临床结局的影响。结果入院时存在营养风险和营养不良的患者共90例，占总调查人数的48．9％，其中胸外科45例（50％），明显高于肿瘤内科11例（12．2％）、综合科6例（6．67％）和头颈科4例（4．44％）等科室。5例超重的肿瘤患者入院时即存在营养风险。174例（94．6％）肿瘤重症患者在ICU治疗期间接受了肠内营养（EN）＋肠外营养（PN）模式的营养支持。存在营养风险和营养不良的90例患者中，55例（61．1％）接受了早期营养支持；无营养风险的87例患者中．有6例（6．9％）接受了营养支持。入院时NRS评分≥3分和NRS评分〈3分的肿瘤重症患者的病死率、机械通气的发生率、机械通气时间和入住ICU时间的差异均无统计学意义（P〉0．05）。NRS评分≥3分的肿瘤重症患者，早期接受营养支持者的病死率、机械通气时间和人住ICU时间均低于未接受营养支持者，差异有统计学意义（P均〈0．01）。结论部分肿瘤重症患者入院时即存在营养不良及营养风险，需尽早制定合理的营养支持计划。当人院时NRS评分≥3分时，早期营养支持有一定的改善肿瘤重症患者临床结局的可能性。

Assessment of nutritional status and application of nutritional support in 184 cancer patients with critical illness

Objective To analyze the nutritional status and application of nutritional support in cancer patients with critical illness after admission. Methods Clinical records of 184 patients in the Intensive Care Unit （ICU） of our Cancer Center from Jan 2009 to Dec 2011 were reviewed and analyzed. The nutritional status was estimated using the Nutritional Risk Screening 2002（NRS2002） on the first 24 hours after admission.The effects of nutritional status, nutritional support,ratio of mechanical ventilation support and clinical outcomes were analyzed. Results Ninety （48.9%） patients needed nutritional support after admission, in which 45 patients were from Thoracic Department, 11 patients were from Oncology Department, 6 patients were from the VIP region and 4 patients were from the Head ＆ Neck Department. 5 overweighed patients were at nutritional risk after admission. 174 （94.6%） critically ill cancer patients received enteral nutrition plus parenteral nutrition support in ICU. 55 patients （61.6%） with nutritional risk and malnutrition received nutrition support, and 6 patients （6.9%） with NRS2002〈3 received nutritional support. There were no statistical differences between NRS I〉3 group and NRS〈3 group in mortality,ratio and duration of mechanical ventilation application and duration of ICU stay （P all〉0.05）. Mortality, duration of mechanical ventilation and duration of ICU stay of patients with NRS2002 I〉 3 receiving early nutritional support were all significantly lower than others not doing so （P all〈0.01 ）. Conclusions Malnutrition and nutritional risk was found at a large proportion of critically ill cancer patients after admission, in which proper nutrition support plan was urgently required. Clinical outcomes of critically ill cancer patients with NRS2002≥ 3 after admission may be improved by early nutritional support.