食管癌高发区围手术期患者营养风险筛查和营养支持应用

摘要

目的 调查食管癌高发区住院患者入院时的营养风险及住院期间的营养支持情况,分析营养风险、营养支持和临床结局的关系.方法 采用营养风险筛查2002(NRS 2002),选取2008年3月至2012年3月在我科住院患者进行营养风险筛查,并调查患者住院2周内的营养支持状况,统计并发症的发生率、住院时间和住院费用.结果 1000例围手术期食管癌患者中,总营养风险发生率为32.1％(321/1000),其中有77.6％(249/321)应用营养支持,而无营养风险患者中有69.7％(473/679)应用营养支持.有营养风险的患者并发症发生率、平均住院时间、总住院费用显著高于无营养风险患者,分别为并发症发生率29.0％(93/321) vs 13.1％(89/679)、平均住院时间(20.1±5.3)天vs(13.6±3.9)天、总住院费用(23175.7±5372.2)元vs (15275.7±3996.4)元(均P＜0.01).有营养风险组患者中应用营养支持患者并发症发生率、平均住院时间、总住院费用显著低于无营养风险组患者,分别为20.1％(50/249) vs59.7％(43/72)、(17.1±6.2) dvs(30.5±9.8)d、(20573.4±4831.2)元vs(32175.2±6213.3)元.结论 食管癌住院患者营养风险发生率较高,营养风险与住院患者的临床结局有关,对食管癌患者营养风险筛查并对有营养风险的患者给予营养支持可改善临床结局.%Objective To determine the prevalence of nutritional risk and application of nutrition support in perioperative patients in high risk area of esophageal carcinoma, and to evaluate the relationship between nutrition support and clinical outcome as well as between nutrition risk and clinical outcome.Methods Perioperative patients in high risk area of esophageal carcinoma in the department were enrolled from March 2008 to March 2012.The patients were screened on admission for using nutritional risks with Nutrition Risk Screening 2002 (NRS 2002).Data were collected on the application of nutrition support within two weeks in hospital stay,complication rate, length of stay,and hospital charges.Results Altogether 1 000 patients were included in the study.The overall prevalence of nutritional risk in the patients was 32.1%(321/1 000),among which 77.6%(249/321) patients received nutrition support,while 69.7%(473/679) in those without nutrition risk got nutrition support.The patients with nutritional risk had higher complication rate,longer length of hospital stay,and higher hospital charge compared with those without nutrition risk, 29.0%(93/321) vs 13.1%(89/679), (20.1± 5.3) d vs (13.6±3.9) d,(23 175.7±5 372.2)yuan vs (15 275.7± 3 996.4) yuan(all P <0.01).The patients with nutrition risk receiving nutrition support had lower complication rate, shorter length of hospital stay,and lower hospital charge compared with those without nutrition risk,20.1%(50/249) vs 59.7%(43/72),(17.1±6.2) d vs (30.5 ± 9.8)d,(20 573.4±4 831.2) yuan vs (32 175.2±6 213.3) yuan(all P < 0.01).Conclusion Patients with esophageal carcinoma in hospital are at high nutrition risk.Nutrition risk relates with their clinical outcome in hospital.Screen for nutrition risk and application of nutrition support to the nutrition risk of perioperative patients may improve their clinical outcome.