摘要
目的：探讨联合应用营养风险筛查2002（NRS 2002）和CONUT 2种营养状况评估工具对结直肠癌根治术后行营养支持治疗的指导价值及对营养支持治疗的临床意义。方法：回顾性分析2012年 6月至2014年6月新疆医科大学附属肿瘤医院收治的180例行结直肠癌手术患者的临床资料。70例NRS 2002评分≥3分的患者设为A组；A组中40例行营养支持治疗患者设为A1组，30例未行营养支持治疗患者设为A2组。60例NRS 2002评分〈3分且CONUT阴性的患者设为B组；B组中30例行营养支持治疗患者设为B1组，30例未行营养支持治疗患者设为B2组。50例NRS 2002评分〈3分但CONUT阳性的患者设为 C组；C组中25例行营养支持治疗患者设为C1组，25例未行营养支持治疗患者设为C2组。联合应用NRS 2002和CONUT 2种工具对患者营养状况进行评估。NRS 2002评分≥3分或NRS 2002评分〈 3分但CONUT阳性为存在营养风险，NRS 2002评分〈3分且CONUT阴性为无营养风险。存在营养风险患者均应于术后尽早行营养支持治疗，告知患者及家属不行营养支持治疗的风险，由患者及家属自行选择。采用肠内营养支持治疗，经管饲补充肠内营养制剂或直接口服营养素，热卡≥41.84 kJ/（kg·d），时间≥ 3 d。观察指标：（1）营养学指标：术前、术后第1天和术后第7天清晨空腹血清Alb、前白蛋白及转铁蛋白。（2）术后恢复情况：术后肛门排气时间，术后排便时间，术后进半流质食物时间，术后住院时间。正态分布的计量资料以±s表示，组间比较采用t检验和重复测量方差分析。计数资料比较采用χ2检验。结果：3组行营养支持治疗患者均耐受良好，无明显腹痛、腹胀、腹泻情况。营养学指标比较：A组中A1组患者术前Alb、前白蛋白、转铁蛋白分别为（29±4）g/L、（0.25±0.06）g/L、（2.0±0.4）g/L，术后第1天分别为（27±4）g/L、（0.19±0.07）g/L、（1.7±0.4）g/L，术后第7天分别为（33±5）g/L、（0.27±0.05）g/L、（1.9± 0.3）g/L；A2组患者术前Alb、前白蛋白、转铁蛋白分别为（29±5）g/L、（0.24±0.04）g/L、（2.0±0.4）g/L，术后第1天分别为（27±4）g/L、（0.18±0.05）g/L、（1.7±0.4）g/L，术后第7天分别为（26±4）g/L、（0.16±0.04）g/L、（1.8±0.5）g/L。两组上述3项指标变化趋势比较，差异均有统计学意义（F=3.256，6.642，7.152，P〈0.05）。B组中B1组患者术前Alb、前白蛋白、转铁蛋白分别为（37±4）g/L、（0.28±0.05）g/L、（2.0±0.3）g/L，术后第1天分别为（36±4）g/L、（0.21±0.06）g/L、（1.7±0.5）g/L，术后第7天分别为（38±4）g/L、（0.30±0.05）g/L、（1.9±0.5）g/L；B2组患者术前Alb、前白蛋白、转铁蛋白分别为（36±4）g/L、（0.28±0.06）g/L、（2.1±0.4）g/L，术后第1天分别为（36±3）g/L、（0.23±0.04）g/L、（1.7±0.4）g/L，术后第7天分别为（37±4）g/L、（0.22±0.07）g/L、（1.8±0.5）g/L。两组上述3项指标变化趋势比较，差异均无统计学意义（F=1.562，0.625，2.223，P〉0.05）。C组中C1组患者术前Alb、前白蛋白、转铁蛋白分别为（28±4）g/L、（0.35±0.06）g/L、（2.1±0.4）g/L，术后第1天分别为（26±4）g/L、（0.17±0.07）g/L、（1.7±0.4）g/L，术后第7天分别为（34±5）g/L、（0.35±0.05）g/L、（1.8±0.3）g/L；C2组患者术前Alb、前白蛋白、转铁蛋白分别为（28±5）g/L、（0.34±0.04）g/L、（2.0±0.4）g/L，术后第1天分别为（26±4）g/L、（0.16±0.05）g/L、（1.7±0.4）g/L，术后第7天分别为（25±4）g/L、（0.16±0.04）g/L、（1.8±0.5）g/L。两组上述3项指标变化趋势比较，差异均有统计学意义（F=5.625，4.225，8.221，P〈005）。术后恢复情况：A组中A1组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为（1.9±0.5）d、（2.3±0.5）d、（8.6±1.2）d、（14.7±1.1）d，A2组分别为（3.0±0.5）d、（4.5±0.6）d、（11.4±2.2）d、（17.8±1.3）d，两组上述指标比较，差异均有统计学意义（t=-0.644，-12.200，-8.710， -11.650，P〈0.05）。B组中B1组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为（1.2±0.3）d、（3.2±0.7）d、（10.3±1.4）d、（14.7±2.0）d，B2组分别为（1.5±0.5）d、（3.7±0.6）d、（11.0±1.2）d、（16.1±1.5）d，两组上述指标比较，差异均无统计学意义（t=-1.929， -1.033，-1.019，-1.171，P〉005）。C组中C1组患者术后肛门排气时间、术后排便时间、术后进半流质食物时间、术后住院时间分别为（1.8±0.7）d、（2.1±0.5）d、（7.6±1.2）d、（13.9±1.2）d，C2组分别为（3.1±0.5）d、（4.5±0.7）d、（11.4±2.4）d、（17.6±1.3）d，两组上述指标比较，差异均有统计学意义（t=-5.934，-10.950，-10.010，-11.700，P〈0.05）。结论：联合应用NRS 2002和CONUT 2种工具评估患者营养状况指导营养支持治疗准确可靠。对存在营养风险的结直肠癌患者，术后应积极行营养支持治疗；但对术前无营养风险患者，术后营养支持治疗不是必需。合理营养支持治疗能改善结直肠癌患者术后营养状况，加速术后恢复，缩短住院时间。
Objective：To investigate the value of guidance and clinical significance of enteral nutritional support therapy using a joint of nutritional risk screening 2002 （NRS2002） and a screening tool for controlling nutritional status （CONUT） after radical resection of colorectal cancer. Methods：The clinical data of 180 patients who underwent radical resection of colorectal cancer at the Tumor Hospital of Xinjiang Medical University between June 2012 and June 2014 were retrospectively analyzed. Seventy patients with scores of NRS 2002≥3 were allocated into the A group including 40 with enteral nutritional support therapy in the A1 group and 30 without enteral nutritional support therapy in the A2 group, 60 patients with scores of NRS 2002〈3 and negative CONUT was allocated into the B group including 30 with enteral nutritional support therapy in the B1 group and 30 without enteral nutritional support therapy in the B2 group, 50 patients with scores of NRS 2002〈3 and positive CONUT was allocated into the C group including 25 with enteral nutritional support therapy in the C1 group and 25 without enteral nutritional support therapy in the C2 group. The nutritional status of patients was evaluated using a joint of NRS 2002 and CONUT. There was nutritional risk in patients with scores of NRS 2002≥3 or scores of NRS 2002〈3 and positive CONUT and no nutritional risk in patients with scores of NRS 2002〈3 and negative CONUT. Patients and their families would choose whether or not to undergo enteral nutritional support therapy after the risks being informed. Enteral nutritional support therapy included tube feeding enteral nutrition or oral nutriments with calories≥41.84 kJ/（kg·d） for more than 3 days. Observed indicators： （1）Nutritional indicators included fasting serum albumin （Alb）, prealbumin and transferrin before operation, at postoperative day 1 and day 7. （2）Post operative recovery included time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay. Measurement data with normal distribution were presented as ±s, comparison among groups was analyzed using the t test and repeated measures ANOVA, and count data were analyzed using the chisquare test. Results：Patients in A, B and C groups had good tolerance without abdominal pain, abdominal distension and diarrhea. Comparisons of nutritional indicators： the levels of fasting serum Alb, prealbumin and transferrin in the A1 group were （29±4）g/L, （0.25±0.06）g/L and （2.0±0.4）g/L before operation, （27±4）g/L, （0.19±0.07）g/L, （1.7±0.4）g/L at postoperative day 1 and （33±5）g/L, （0.27±0.05）g/L and （1.9±0.3）g/L at postoperative day 7, respectively. The levels of fasting serum Alb, prealbumin and transferrin in the A2 group were （29±5）g/L, （0.24±0.04）g/L and（2.0±0.4）g/L before operation,（27±4）g/L, （0.18±0.05）g/L and （1.7±0.4）g/L at postoperative day 1 and （26±4）g/L, （0.16±0.04）g/L and （1.8±0.5）g/L at post operative day 7, respectively. There were significant differences in the changing trends of the above 3 indicators between the 2 groups （F=3.256, 6.642, 7.152, P〈0.05）. The levels of fasting serum Alb, prealbumin and transferrin in the B1 group were （37±4）g/L, （0.28±0.05）g/L and （2.0±0.3）g/L before operation, （36±4）g/L, （0.21±0.06）g/L and （1.7±0.5）g/L at postoperative day 1 and （38±4）g/L, （0.30±0.05）g/L and （1.9±0.5）g/L at postoperative day 7, respectively. The levels of fasting serum Alb, prealbumin and transferrin in the B2 group were （36±4）g/L, （0.28±0.06）g/L and （2.1±0.4）g/L before operation, （36±3）g/L, （0.23±0.04）g/L and （1.7±0.4）g/L at postoperative day 1 and （37±4）g/L, （0.22±0.07）g/L and （1.8± 0.5）g/L at postoperative day 7, respectively. There was no significant difference in the changing trends of the above 3 indicators between the 2 groups （F=1.562, 0.625, 2.223, P〉0.05）. The levels of fasting serum Alb, prealbumin and transferrin in the C1 group were （28±4）g/L, （0.35±0.06）g/L and （2.1±0.4）g/L before operation, （26±4）g/L, （0.17±0.07）g/L and （1.7±0.4）g/L at postoperative day 1 and （34±5）g/L, （0.35±0.05）g/L and （1.8±0.3）g/L at postoperative day 7, respectively. The levels of fasting serum Alb, prealbumin and transferrin in the C2 group were（28±5）g/L,（0.34±0.04）g/L and （2.0±0.4）g/L before operation, （26±4）g/L, （0.16±0.05）g/L and （1.7±0.4）g/L at postoperative day 1 and （25±4）g/L, （0.16±0.04）g/L and （1.8±0.5）g/L at postoperative day 7, respectively. There were significant differences in the changing trends of the above 3 indicators between the 2 groups （F=5.625, 4.225, 8.221, P〈0.05）. Postoperative recovery： time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were （1.9±0.5）days, （2.3±0.5）days, （8.6±1.2）days, （14.7±1.1）days in the A1 group and （3.0±0.5）days, （4.5±0.6）days, （11.4±2.2）days, （17.8±1.3）days in the A2 group, respectively, with significant differences between the 2 groups （t=-0.644,-12.200,-8.710,-11.650, P〈0.05）. Time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were （1.2± 0.3）days, （3.2±0.7）days, （10.3±1.4）days, （14.7±2.0）days in the B1 group and （1.5±0.5）days, （3.7±0.6）days, （11.0±1.2）days, （16.1±1.5）days in the B2 group, respectively, with no significant difference between the 2 groups （t=-1.929,-1.033,-1.019,-1.171, P〉0.05）. Time to anal exsufflation, time of defecation, time for semifluid diet intake and duration of hospital stay were （1.8±0.7）days, （2.1±0.5）days, （7.6±1.2）days, （13.9±1.2）days in the C1 group and （3.1±0.5）days, （4.5±0.7）days, （11.4±2.4）days, （17.6±1.3）days in the C2 group, respectively, with significant differences between the 2 groups （t=-5.934,-10.950,-10.010,-11.700, P〈0.05）. Conclusions：A joint application of NRS2002 and CONUT after radical resection of colorectal cancer is exact and feasible for evaluating nutritional status of patients and guiding enteral nutritional support therapy. Patients should select nutritional support therapy after operation if there is nutritional risk. The proper nutritional support therapy can improve the postoperative nutritional status of patients with colorectal cancer, enhance the postoperative recovery and reduce the duration of hospital stay.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第10期852-857,共6页
Chinese Journal of Digestive Surgery
关键词
结直肠肿瘤
营养支持治疗
肠内
营养风险筛查2002
CONUT
Colorectal neoplasms
Nutrition support therapy, enteral
Nutritional risk screening2002
Controlling nutritional status
