摘要:
目的：探讨术前营养评估及干预对胃癌根治术疗效的影响。方法：纳入河北北方学院附属第一医院普通外科择期行胃癌根治术的105例胃癌患者。采用NRS 2002评分对其进行术前营养评估：≥3分为存在营养风险（营养风险组43例），<3分为营养正常（无营养风险组62例）。两组根据是否给予营养支持再分为未行营养支持和营养支持两亚组。比较各组患者术后恢复情况（首次排气、排便、下床、平均住院时间）、营养、免疫状况和并发症发生情况。结果：营养风险组中，营养支持患者的首次排气时间、排便时间和下床时间均明显早于未行营养支持患者，差异有统计学意义（P<0.05）；营养支持患者平均住院时间早于未营养支持患者，差异有统计学意义（P<0.001）。无营养风险组两亚组术后恢复情况差异无统计学意义。营养风险组中，营养支持患者术后第5天的血清前白蛋白（PAB）、转铁蛋白（TRF）和白蛋白（ALB）均明显高于未营养支持患者，差异有统计学意义（P<0.05）；无营养风险组两亚组上述指标差异无统计学意义。营养风险组中营养支持患者术后第5天的IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+均明显高于未营养支持患者，差异有统计学意义（P<0.05）；无营养风险组两亚组上述指标差异无统计学意义。营养风险组中营养支持患者并发症发生率为10.34%，明显低于未营养支持患者（35.71%），差异有统计学意义（P<0.05）；无营养风险组两亚组并发症发生率差异无统计学意义。结论：术前对胃癌患者进行营养评估并针对性地给予营养支持能明显改善患者的营养状况及免疫功能，减少术后并发症，促进康复。
Abstract:
Objective：To investigate the effect of preoperative nutrition assessment and intervention on the curative effect of gastric cancer surgery. Methods：Totally 105 patients with gastric cancer were included in the Department of General Surgery of the First Affiliated Hospital of Hebei North University for radical gastrectomy of gastric cancer.The preoperative nutrition assessment was performed with Nutrition Risk Screening 2002 (NRS 2002)—the patients with greater than or equal to 3 points had nutritional risk (the nutritional risk group, n=43 ) and the patients with less than 3 points had normal nutrition (the non-nutritional risk group, n=62). The two groups were further divided into the nutrition support subgroup and the non-nutrition support subgroup. The postoperative recovery (first exhaust time, first defecation time, first ambulation, and average hospitalization time), nutrition, immune function, and complications were compared. Results：In the nutritional risk group, the first exhaust time, first defecation time, and first ambulation time of patients in the nutrition support group were significantly earlier than those in the non-nutrition support group, and the differences were statistically significant (P<0.05). The average length of hospitalization of the patients in the nutrition support group was significantly earlier than that in the non-nutrition support group, and the difference was statistically significant (P<0.001). In the non-nutritional risk group, there was no significant difference in the postoperative recovery between the two subgroups. In the nutritional risk group, serum prealbumin (PAB), transferrin (TRF), and albumin (ALB) of patients in the nutrition support group on the fifth day after operation were significantly higher than those in the non-nutrition support group, and the differences were statistically significant (P<0.05). There was no significant difference in the above indexes between the two subgroups of the non-nutritional risk group. In the nutritional risk group, IgA, IgG, IgM, CD3+, CD4+, and CD4+/CD8+ of patients in the nutrition support group on the fifth day after operation were significantly higher than those in the non-nutrition support group, and the differences were statistically significant (P<0.05). There was no significant difference in the above indexes between the two subgroups of the non-nutritional risk group. In the nutritional risk group, the incidence of complications was 10.34% in the nutrition support group, which was significantly lower than that 35.71% in the non-nutrition support group, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of complications between the two subgroup of the non-nutritional risk group. Conclusions：Preoperative nutritional assessment of patients with gastric cancer and targeted nutritional support can significantly improve the nutritional status and immune function, reduce postoperative complications, and promote recovery.
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