• 上海交通大學(xué)附屬第六人民醫(yī)院普外科(上海 200233);

目的調(diào)查胃腸腫瘤住院患者營養(yǎng)風(fēng)險及住院期間的營養(yǎng)支持狀況，分析營養(yǎng)風(fēng)險與腫瘤分期、營養(yǎng)支持及并發(fā)癥的關(guān)系。方法選擇我院2009年9月至2011年6月期間住院的胃腸腫瘤患者，入院時使用營養(yǎng)風(fēng)險篩查工具2002（NRS2002）進行營養(yǎng)風(fēng)險篩查，并調(diào)查住院期間的營養(yǎng)支持狀況，統(tǒng)計患者的腫瘤分期及并發(fā)癥發(fā)生率。結(jié)果共有961例住院患者入選，總營養(yǎng)風(fēng)險發(fā)生率為38.9%(374/961)，胃腫瘤和結(jié)直腸腫瘤分別為49.2%（176/358）和32.8%（198/603）。Ⅳ期的胃腫瘤和結(jié)直腸腫瘤營養(yǎng)風(fēng)險最高〔87.3%(48/55)和58.8%(50/85)〕，ⅡA期的胃腫瘤和Ⅰ期的結(jié)直腸腫瘤營養(yǎng)風(fēng)險最低〔16.1%(5/31)和9.8%(6/61)〕。有營養(yǎng)風(fēng)險和無營養(yǎng)風(fēng)險胃腫瘤患者的營養(yǎng)支持率分別為62.3%(152/244)和48.6%(144/296)，有營養(yǎng)風(fēng)險和無營養(yǎng)風(fēng)險結(jié)直腸腫瘤患者的營養(yǎng)支持率分別為37.7%(92/244)和51.4%(152/296)，腸外營養(yǎng)和腸內(nèi)營養(yǎng)比值為1.251。有營養(yǎng)風(fēng)險的胃腸腫瘤患者并發(fā)癥發(fā)生率為32.4%(121/374)，明顯高于無營養(yǎng)風(fēng)險患者的20.4%(120/587)，P=0.000 0。有營養(yǎng)風(fēng)險的胃腸腫瘤患者應(yīng)用營養(yǎng)支持者并發(fā)癥發(fā)生率為27.5%(67/244)，明顯低于未用營養(yǎng)支持患者的40.8%(53/130),P=0.008 6。在無營養(yǎng)風(fēng)險的胃腫瘤患者中應(yīng)用營養(yǎng)支持者并發(fā)癥發(fā)生率明顯低于未用營養(yǎng)支持者（P=0.039 6），而在無營養(yǎng)風(fēng)險的結(jié)直腸腫瘤患者中應(yīng)用營養(yǎng)支持與否與并發(fā)癥發(fā)生率無關(guān)（P=0.464 7）。結(jié)論胃腸腫瘤住院患者營養(yǎng)風(fēng)險較高，營養(yǎng)風(fēng)險發(fā)生率與腫瘤分期有關(guān); 有營養(yǎng)風(fēng)險的胃腸腫瘤患者并發(fā)癥發(fā)生率高于無營養(yǎng)風(fēng)險者; 給予有營養(yǎng)風(fēng)險的胃腸腫瘤患者營養(yǎng)支持可以減少并發(fā)癥的發(fā)生。

引用本文： 賈震易,秦環(huán)龍. 胃腸腫瘤患者營養(yǎng)風(fēng)險與營養(yǎng)支持調(diào)查分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(12): 1254-1258. doi: 復(fù)制

1. Pirliah M, Sohutz T, Norman K, et al. The German hospital mainutrtion study [J]. Clin Nutr, 2006, 25(4): 563572.
2. 郭志義， 胡陽， 龐明輝, 等. 高齡胃癌病人的圍手術(shù)期處理及營養(yǎng)支持 [J]. 中國實用外科雜志， 2005，25(4): 154156.
3. 蔣朱明, 陳偉, 朱賽楠, 等． 中國東、中、西部大城市三甲醫(yī)院營養(yǎng)不良(不足)、營養(yǎng)風(fēng)險發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查 [J]．中國臨床營養(yǎng)雜志, 2008, 16(6): 335337．.
4. 陳春明． 中國成人體質(zhì)指數(shù)分類的推薦意見簡介 [J]. 中華預(yù)防醫(yī)學(xué)雜志， 2001, 35(5)： 349350.
5. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
6. 陳偉, 蔣朱明, 張永梅, 等． 歐洲營養(yǎng)不良風(fēng)險調(diào)查方法在中國住院患者的臨床可行性研究 [J]．中國臨床營養(yǎng)雜志, 2005, 13(3): 137141．.
7. American Gastroenterological Association. American gastroenterological association medical position statement: parenteral nutrition [J]. Gastroenterology, 2001, 121(4): 966969.
8. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
9. Buzby GP, Knox LS, Crosby LO, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients [J]. Am J Clin Nutr, 1988, 47(2 Suppl): 366381.
10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey [J]. Ann Surg, 2004, 240(2): 205213.
11. Warneke VS, Behrens HM, Hartmann JT, et al. Cohort study based on the seventh edition of the TNM classification for gastric cancer: proposal of a new staging system [J]. J Clin Oncol, 2011, 29(17): 23642371.
12. 劉蔭華, 徐玲． 第七版《AJCC腫瘤分期手冊》結(jié)直腸癌內(nèi)容的更新與解讀 [J]．中華胃腸外科雜志, 2010, 13(8): 629631．.
13. 丁國平, 陳平, 易占波, 等. 胃癌患者術(shù)前營養(yǎng)風(fēng)險篩查及預(yù)防性腸內(nèi)營養(yǎng)支持 [J]. 中華胃腸外科雜志, 2009, 12(2): 141144.
14. 郭衛(wèi)平, 衛(wèi)洪波, 李璽, 等. 應(yīng)用營養(yǎng)風(fēng)險篩查2002評分系統(tǒng)對胃癌患者術(shù)前營養(yǎng)風(fēng)險的評估 [J]. 中華普通外科雜志, 2009, 24(10): 824826.
15. Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results [J]. J Gastroenterol Hepatol, 2010, 25(4): 800803.
16. 梁曉坤, 蔣朱明, Nolan MT, 等. 北京教學(xué)醫(yī)院普通外科住院患者營養(yǎng)風(fēng)險、營養(yǎng)不足、超重、肥胖及營養(yǎng)支持狀況 [J]. 中國臨床營養(yǎng)雜志, 2009, 17(2): 7578.
17. Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
18. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.
19. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
20. Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer [J]. Br J Surg, 2010, 97(1): 9297.
  1. 1. Pirliah M, Sohutz T, Norman K, et al. The German hospital mainutrtion study [J]. Clin Nutr, 2006, 25(4): 563572.
  2. 2. 郭志義， 胡陽， 龐明輝, 等. 高齡胃癌病人的圍手術(shù)期處理及營養(yǎng)支持 [J]. 中國實用外科雜志， 2005，25(4): 154156.
  3. 3. 蔣朱明, 陳偉, 朱賽楠, 等． 中國東、中、西部大城市三甲醫(yī)院營養(yǎng)不良(不足)、營養(yǎng)風(fēng)險發(fā)生率及營養(yǎng)支持應(yīng)用狀況調(diào)查 [J]．中國臨床營養(yǎng)雜志, 2008, 16(6): 335337．.
  4. 4. 陳春明． 中國成人體質(zhì)指數(shù)分類的推薦意見簡介 [J]. 中華預(yù)防醫(yī)學(xué)雜志， 2001, 35(5)： 349350.
  5. 5. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
  6. 6. 陳偉, 蔣朱明, 張永梅, 等． 歐洲營養(yǎng)不良風(fēng)險調(diào)查方法在中國住院患者的臨床可行性研究 [J]．中國臨床營養(yǎng)雜志, 2005, 13(3): 137141．.
  7. 7. American Gastroenterological Association. American gastroenterological association medical position statement: parenteral nutrition [J]. Gastroenterology, 2001, 121(4): 966969.
  8. 8. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
  9. 9. Buzby GP, Knox LS, Crosby LO, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients [J]. Am J Clin Nutr, 1988, 47(2 Suppl): 366381.
  10. 10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey [J]. Ann Surg, 2004, 240(2): 205213.
  11. 11. Warneke VS, Behrens HM, Hartmann JT, et al. Cohort study based on the seventh edition of the TNM classification for gastric cancer: proposal of a new staging system [J]. J Clin Oncol, 2011, 29(17): 23642371.
  12. 12. 劉蔭華, 徐玲． 第七版《AJCC腫瘤分期手冊》結(jié)直腸癌內(nèi)容的更新與解讀 [J]．中華胃腸外科雜志, 2010, 13(8): 629631．.
  13. 13. 丁國平, 陳平, 易占波, 等. 胃癌患者術(shù)前營養(yǎng)風(fēng)險篩查及預(yù)防性腸內(nèi)營養(yǎng)支持 [J]. 中華胃腸外科雜志, 2009, 12(2): 141144.
  14. 14. 郭衛(wèi)平, 衛(wèi)洪波, 李璽, 等. 應(yīng)用營養(yǎng)風(fēng)險篩查2002評分系統(tǒng)對胃癌患者術(shù)前營養(yǎng)風(fēng)險的評估 [J]. 中華普通外科雜志, 2009, 24(10): 824826.
  15. 15. Guo W, Ou G, Li X, et al. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results [J]. J Gastroenterol Hepatol, 2010, 25(4): 800803.
  16. 16. 梁曉坤, 蔣朱明, Nolan MT, 等. 北京教學(xué)醫(yī)院普通外科住院患者營養(yǎng)風(fēng)險、營養(yǎng)不足、超重、肥胖及營養(yǎng)支持狀況 [J]. 中國臨床營養(yǎng)雜志, 2009, 17(2): 7578.
  17. 17. Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
  18. 18. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.
  19. 19. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
  20. 20. Schwegler I, von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer [J]. Br J Surg, 2010, 97(1): 9297.