胃癌患者术前营养风险筛查及预防性肠内营养支持

目的研究营养风险筛查（NRS 2002）评价胃癌患者术前营养状况的可行性与临床适用性，探讨对伴有营养风险的患者行预防性肠内营养支持的临床意义。方法对60例胃癌患者进行NRS 2002评分。将NRS阳性组患者随机分为对照组和试验组，试验组术前3d在正常饮食基础上每天口服能全力1000m1（4184 kJ／L），对照组继续日常饮食。术后观察各组感染并发症发生情况和血清白蛋白、免疫球蛋白及体质量等指标的变化。结果胃癌患者NRS阳性率70％（42／60），NRS阴性组（无营养不良风险）18例。NRS阴性患者术后白蛋白水平明显高于NRS阳性对照组（P〈0．01）；血清IgA、IgM水平亦高于NRS阳性对照组（P〈0．05）；体质量也优于NRS阳性对照组（P〈0．01）。NRS阳性试验组术后血清白蛋白和IgA水平均较同期对照组高（P〈0．05和P〈0．01），体质量下降幅度较对照组少（P〈0．01）；感染并发症两组比较差异无统计学意义（P〉0．05）。结论NRS2002评分方法适用于胃癌患者术前营养不良风险的评估。对伴有营养风险的胃癌患者进行术前肠内营养支持能有效改善其术后的营养状态和提高其胃肠道免疫功能。

Roles of nutrition risk screening and preventive enteral nutritional support before radical resection of gastric cancer

Objective To investigate the potential role of the preventive nutritional support in patients with nutritional risk defined by nutrition risk screening 2002 (NRS 2002) before radical resection of gastric cancer. Methods Patients with gastric cancer were evaluated by NRS 2002 preoperatively. Elective patients with nutritional risk were randomly assigned into 3 d preventive enteral nutrition(EN) group versus control group. The preventive nutrition regimen was 1000 ml Nutrison Multi Fibre (4184 kJ/L). The changes in body weight lost, serum albumin, immunoglobulin were recorded postoperatively. Results One week after operation, the preventive EN group showed less decrease in body weight as compared to control group, which was statistically significant. The levels of serum albumin and IgA on day 1 and day 3 after operation in preventive EN group were significantly higher than those in control group. Conclusion Before operation for gastric cancer, patients with nutritional risk defined by NRS 2002 may benefit from preventive enteral nutrition, which improves the patients' nutritional condition and enhances their immunologic function.