摘要
目的观察老年胃肠道肿瘤患者围手术期静息能量代谢的变化规律。方法选择65-80岁胃肠道肿瘤患者73例,采用自身对照研究方法,于手术前、术后3-5d、术后7-10d三个时间点采用MedGeM床旁代谢仪测量静息能量代谢(restingenergy expenditure,REE),测量身高、体重、计算体重指数(BMI),微型营养评定(mini nutritional assesment,MNA)法评估营养状况,检测血生化指标及血前白蛋白、C反应蛋白。结果所有胃肠肿瘤患者术后3-5d的REE与术前比较无统计学差异(男术后3-5d(4 869.07±432.31)kJ/d vs术前(4 629.10±421.68)kJ/d,女术后3-5d(4 062.12±502.49)kJ/d vs术前(3 892.63±488.29)kJ/d,(P>0.05);与术前和术后3-5d比较,术后7-10d男性REE胃肠肿瘤患者均显著降低(男胃肿瘤术后7-10d(3 443.15±385.02)kJ/d vs术前(4 340.22±418.82)kJ/d和术后3-5d(4 600.47±434.45)kJ/d,男肠肿瘤术后7-10d(4 137.11±347.21)kJ/d vs术前(5 012.36±455.15)kJ/d和术后3-5d(5 091.66±421.89)kJ/d,(P<0.05);女性仅肠肿瘤患者显著降低(术后7-10d(3 766.56±388.08)kJ/d vs术前(4 180.08±305.86)kJ/d和术后3-5d(4 477.11±416.47)kJ/d,P<0.05)。男性患者术后3-5d和7-10d的血红蛋白值、淋巴细胞总数与术前比较均显著下降(术后3-5d和7-10d血红蛋白(131.07±24.18)g/L和(125.08±23.82)g/L vs术前(147.79±14.82)g/L,术后3-5d和7-10d淋巴细胞总数(1 363.95±570.76)/ml和(1 316.78±589.66)/mlvs术前(1 667.98±600.15)/ml,P<0.05),其他指标以及女性的各项生化检验指标在三个时间段之间比较均无统计学差异(P>0.05)。无论男女与术前比较,术后3-5d和7-10d的BMI值及MNA评分均显著下降(男术后3-5d和7-10dBMI值(22.02±2.07)kg/m2和(21.45±2.89)kg/m2 vs术前(23.11±2.11)kg/m2,女术后3-5d和7-10d BMI值(20.77±2.08)kg/m2和(20.06±2.16)kg/m2 vs术前(21.04±1.99)kg/m2,男术后3-5d和7-10dMNA评分20.58±6.22和20.92±8.15 vs术前22.98±5.48,女术后3-5d和7-10d MNA评分(20.33±9.16)和(19.98±6.88)vs术前(23.12±6.26),P<0.05)。结论老年胃肠道肿瘤患者术后静息能量消耗与术前比较呈下降趋势,可能与术后BMI、血红蛋白、淋巴细胞总数及MNA评分下降有关。
Objective To observe the changing rules of resting energy metabolism （REM） in perioperative elderly patients with gastrointestinal tumor. Methods Seventy-three elderly patients with gastrointestinal tumor at the age of 65-80 years were included in this control study. Their REM was assayed before and 3-5d and 7-10d after surgery by indirect calorimetry （MedGem）. Their body height, body weight, body mass index （BMI）, biochemical indications, albumin and C-creative protein （CRP） level were measured. Their nutritional status was tested following the mini nutritional assessment （MNA） score. Results No significant difference was found in REE among the patients before and 3-5d after surgery （4 869.07 ± 432.31）kJ/d vs （4 629.10 ± 421.68）kJ/d in males, （4 062.12 _± 502.49）kJ/d vs （3 892.63 ± 488.29）kJ/d in females, P〉0.05）. The REE was significantly lower in male and female patients 7-10d after surgery than before and 3-5d after surgery （3 443.15 ± 385.02）kJ/d vs （4 340.22 ± 418.82）kJ/d and （4 600.47 ± 434.45）kJ/d, （4 137.11 ± 347.21）kJ/d vs （5 012.36±455.15）kJ/d and （5 091.66 ± 421.89）kJ/d in male patients, and （3 766.56 ± 388.08）kJ/d vs （4 180.08 ± 305.86）kJ/d and （4 477.11± 416.47）kJ/d in female patients, （P〈0.05）. The hemoglobin level and total number of lymphocytes were significantly lower in male patients 3-5d and 7-10d after surgery than before surgery （131.07 ± 24.18）g/L and （125.08 ± 23.82）g/L vs （147.79 ± 14.82）g/L, （1 363.95 ± 570.76）/ml and （1 316.78 ± 589.66）/ml vs （1 667.98 ± 600.15）/ml, （P〈0.05）.The BMI and MNA score were significantly lower in male and female patients after surgery than before surgery （22.02 ± 2.07）kg/m^2 and （21.45 ± 2.89）kg/m^2 vs （23.11 ± 2.11）kg/m^2, （20.77 ± 2.08）kg/m^2 and （20.06 ± 2.16）kg/m^2 vs （21.04 ± 1.99）kg/m^2 in male patients, 20.58_± 6.22 and 20.92 ± 8.15 vs 22.98 ± 5.48, 20.33 ± 9.16 and 19.98 ± 6.88 vs 23.12 ±6.26 in female patients, （P〈0.05）. Conclusion The REM of elderly patients with gastrointestinal tumor tends to decrease after surgery, which may be related with the decreased BMI, hemoglobin, total number of lymphocytes and MNA score.
出处
《军医进修学院学报》
CAS
2012年第9期916-919,共4页
Academic Journal of Pla Postgraduate Medical School
关键词
胃肠道肿瘤
老年
静息代谢
围手术期
gastrointestinal cancer
elderly
resting energy metabolism
perioperative
