术前营养风险对根治性全膀胱切除术后并发症发生率的影响

目的：分析存在营养风险的患者较无营养风险的患者在行根治性全膀胱切除术后并发症发生率是否存在差别。方法：选择2010年至2013年在南京医科大学第一附属医院泌尿外科行根治性全膀胱切除术患者，共147例，评估患者术前营养风险状态，量化为营养风险筛查工具2002（nutritional risk screening，NRS2002）评分。根据Clavien-Dindo 评分系统判定术后并发症，分析术后并发症的危险因素。结果：年龄≥70岁的患者处于高营养风险的比例更高（P=0.023）；存在营养风险的63例患者中，有39例（61.90%）术后至少发生了一种并发症，高于无营养风险的患者（29/84，34.52%，P=0.001）；存在营养风险的患者术后发生并发症的风险是无营养风险患者的3.128倍(OR=3.128，95%CI 1.538~6.361，P=0.002)；存在营养风险的患者较无营养风险组患者的术后住院时间更长［（12.9±5.7） d vs. （10.4±4.3） d, P=0.003］。结论：≥70岁的患者较＜70岁的患者更易存在营养风险，存在营养风险的患者在全膀胱根治性切除术后更易发生并发症。

Impact of preoperative nutritional risk on complications after radical cystectomy

Objective:To evaluate whether urological patients at nutritional risk are at higher risk for complications after radical cystectomy than those not at nutritional risk .Methods:We performed a retro-spective observational study in the consecutive patients undergoing radical cystectomy between 2010 and 2013 .A total of 147 patients were enrolled in this study .The nutritional risk score was assessed preoper-atively by a specialized study nurse .The patients with NRS ( nutritional risk screening ,NRS2002) scores≥3 were considered to have nutritional deficiency .Postoperative complications were defined using the standardized Clavien-Dindo classification .Univariate and multivariate analyses were performed to identify the predictors of complications.Results:The patients aged ≥70 years(50.57%) were more prone to nutritional risk than those aged <70 years (31.67%, P=0.023).Of the 63 patients at nutritional risk, 39 (61.90%) presented with at least 1 complication compared with 29 of the 84 controls (34.52%, P=0 .001 ) .The patients at nutritional risk were at threefold risk for complications on binary Logistic analysis (OR=3.128,95%CI 1.538-6.361,P=0.002).The length of hospital stay of the patients at higher nutritional risk was longer than that of those without nutritional risk [(12.9 ±5.7) d vs.(10.4 ± 4.3) d, P=0.003].Conclusion:The patients aged ≥70 years are at higher nutritional risk than that of those aged <70 years .Patients at nutritional risk are more prone to complications after radical cystectomy .