结直肠癌手术患者术前营养风险筛查及营养支持状况调查

目的：调查结直肠癌（CRC）手术患者术前营养风险发生率及营养支持状况,为临床开展合理营养支持提供参考。方法：采用定点连续抽样法,选择2011年10月-2012年4月宁夏医科大学总医院的CRC手术患者为研究对象,于入院次日晨使用营养风险筛查2002（NRS-2002）对其进行营养风险筛查,并调查其营养支持状况。NRS≥3分判定为有营养风险,体重指数（BMI）〈18.5kg·m-2判定为营养不良。临床营养支持包括肠内营养与肠外营养。结果：共有120例患者入选并完成NRS评分,NRS-2002适用率为100%;入院时营养不良发生率为8.33%,营养风险发生率为65.00%,其中年龄≥65岁患者营养风险发生率（41.67%）高于年龄〈65岁患者（23.33%）（P〈0.05）。营养支持均在术后进行,肠外营养与肠内营养比例为34.7∶1。结论：NRS-2002适用于CRC手术患者的营养风险筛查。部分CRC手术患者术前存在营养风险,应重视患者入院时的营养风险筛查。肠内营养支持比例明显偏低,存在依赖肠外营养支持的不合理现象。建议通过营养支持小组（NST）协作机制,由医、药、护、营养、检验等专业人员共同完成合理的临床营养治疗。

Nutritional Risk Screening and Nutritional Support Survey in Patients before Colorectal Cancer Surgery

OBJECTIVE： To investigate the incidence of nutritional risk and nutritional support before colorectal cancer （CRC） surgery, and to provide evidence for the rational application of nutritional support. METHODS： The patients undergoing CRC surgery in our hospital during Oct. 2011-Apr. 2012 were consecutively enrolled in this study. Nutritional Risk Screening 2002 （NRS-2002） was conducted on the next morning after admission and the application of nutritional support was investigated. Nutritional risk was defined as NRS-2002 score ≥3, and undernutrition was defined as BMI18.5 kg·m-2. Clinical nutrition support included parenteral nutrition and enteral nutrition. RESULTS： A total of 120 patients were enrolled, and NRS-2002 scoring was conducted in all the patients. The incidence of undernutrition was 8.33%, and the incidence of nutritional risk was 65.00% in the patients at admission. The incidence of nutritional risk of the elderly patients （≥65 years old） was 41.67% and higher than 23.33% of the younger patients （65 years old）（P0.05）. The nutritional support was provided after operation usually, and the ratio of parenteral nutrition to enteral nutrition was 34.7∶1. CONCLUSION： NRS-2002 is suitable for nutritional risk screening in patients undergoing CRC surgery. Parts of CRC patients suffer from nutritional risk, so we should pay attention to nutritional risk screening at admission. The enteral nutrition support takes up the small proportion, and nutritional support is currently somehow inappropriate. It is suggested to set up NST, including doctor, pharmacist, nurse, dietitian and checker, to provide rational clinical nutritional therapy.