• 四川大學(xué)華西醫(yī)院胃腸外科中心(四川成都 610041);

目的應(yīng)用營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查(NRS)2002方法對(duì)胃癌住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)狀況、營(yíng)養(yǎng)不良發(fā)生率和營(yíng)養(yǎng)支持現(xiàn)狀進(jìn)行調(diào)查。方法對(duì)2009年6月至2010年2月期間在我院胃腸外科中心住院的胃癌患者進(jìn)行營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查。根據(jù)患者疾病嚴(yán)重程度、營(yíng)養(yǎng)狀況〔包括體重指數(shù)(BMI)、近期體重和進(jìn)食情況〕及年齡3個(gè)方面，評(píng)定營(yíng)養(yǎng)風(fēng)險(xiǎn)。NRS ≥3分為有營(yíng)養(yǎng)風(fēng)險(xiǎn)，NRS lt;3分為無營(yíng)養(yǎng)風(fēng)險(xiǎn); BMI lt;18.5 kg/m2或白蛋白 lt;30 g/L并結(jié)合臨床情況判定是否營(yíng)養(yǎng)不良(不足)。結(jié)果本研究共納入386例患者，其中329例成功完成篩查。有營(yíng)養(yǎng)風(fēng)險(xiǎn)者165例(50.15%)，無營(yíng)養(yǎng)風(fēng)險(xiǎn)者164例(49.85%)。329例患者中營(yíng)養(yǎng)不良者57例(17.33%); 按照性別: 231例男性胃癌患者中營(yíng)養(yǎng)不良(不足)38例，所占比例為16.45%，有營(yíng)養(yǎng)風(fēng)險(xiǎn)者111例，占48.05%; 98例女性胃癌患者中營(yíng)養(yǎng)不良(不足)19例，所占比例為19.39%，有營(yíng)養(yǎng)風(fēng)險(xiǎn)者54例，占55.10%。329例胃癌患者中有237例實(shí)施了臨床營(yíng)養(yǎng)支持(72.04%)，其中有營(yíng)養(yǎng)風(fēng)險(xiǎn)患者165例中，實(shí)施臨床營(yíng)養(yǎng)支持者115例(69.70%)，無營(yíng)養(yǎng)風(fēng)險(xiǎn)患者164例中實(shí)施臨床營(yíng)養(yǎng)支持122例(74.39%)。結(jié)論目前胃癌住院患者營(yíng)養(yǎng)不良發(fā)生率及有營(yíng)養(yǎng)風(fēng)險(xiǎn)者比例均較高，并且臨床營(yíng)養(yǎng)支持存在不合理性，這需要進(jìn)一步推廣和應(yīng)用基于證據(jù)的臨床營(yíng)養(yǎng)支持指南以改善此狀況。

引用本文： 楊平,陳博,伍曉汀. 胃癌住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)及臨床營(yíng)養(yǎng)支持現(xiàn)狀調(diào)查. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(6): 620-624. doi: 復(fù)制

1. 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 clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
2. Gur AS, Atahan K, Aladag I, et al. The efficacy of Nutrition Risk Screening2002 (NRS2002) to decide on the nutritional support in general surgery patients [J]. Bratisl Lek Listy, 2009, 110(5): 290292.
3. Kondrup J, Allison SP, Elia M, et al. ESPEN Guidelines for nutrition screening 2002 [J], Clin Nutr, 2003, 22 (4): 415421.
4. Raslan M, Gonzalez MC, Dias MC, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients [J]. Nutrition, 2010, 26(78): 721726.
5. 蔣朱明, 陳偉, 朱賽楠, 等. 我國(guó)東、中、西部大城市三甲醫(yī)院營(yíng)養(yǎng)不良(不足)、營(yíng)養(yǎng)風(fēng)險(xiǎn)發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況調(diào)查 [J]． 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 335337.
6. 蔣朱明, 于康, 朱賽楠, 等. 我國(guó)東中西部中小醫(yī)院住院患者營(yíng)養(yǎng)不足、營(yíng)養(yǎng)風(fēng)險(xiǎn)、超重和肥胖發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況調(diào)查 [J]. 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 338340.
7. 中華人民共和國(guó)衛(wèi)生部疾病控制司. 中國(guó)成人超重和肥胖癥預(yù)防控制指南 [M]. 北京: 人民衛(wèi)生出版社, 2006: 146.
8. Bruce RS, Blackburn GI， Joseph Vitale， et al． Prevalence of malnutrition in general medical patients [J]． JAMA, 1976, 235(4): 15671570.
9. Twomey C, Briet F, Jeejeebhoy KN. Adeverse effect of malnutrition on lymphocyte mitochondrialcomplex I activity in humans [J]. Clin Nutr, 1994,18（1）: 48.
10. van der Hulst RR, von Meyenfeldt MF, van Kreel BK, et al. Gut permeability, intestinal morphology, and nutritional depletion [J]. Nutrition, 1998, 14(1): 16.
11. 張明鳴, 周勇, 伍曉汀. 生長(zhǎng)激素短期應(yīng)用對(duì)胃腸外科手術(shù)后患者營(yíng)養(yǎng)狀況和血清IGF1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(12): 968973.
12. 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.
13. Burden ST, Hill J, Shaffer JL, et al. Nutritional status of preoperative colorectal cancer patients [J]. J Hum Nutr Diet， 2010, 23(4): 402407.
14. Caccialanza R, Klersy C, Cereda E, et al. Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients [J]. CMAJ, 2010, 182(17): 18431849.
15. 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.
16. 袁琮韋華, 李俊生, 嵇振嶺, 等. 全腸外營(yíng)養(yǎng)及早期腸內(nèi)營(yíng)養(yǎng)在胃癌全胃切除術(shù)后患者中的對(duì)比研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17（4）: 357362.
17. 中華醫(yī)學(xué)會(huì)． 住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查． 臨床診療指南腸外腸內(nèi)營(yíng)養(yǎng)學(xué)分冊(cè)(2008版) [M]． 北京: 人民衛(wèi)生出版社, 2009: 1620．.
18. Drescher T, Singler K, Ulrich A, et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients [J]. Eur J Clin Nutr, 2010, 64(8): 887893.
19. Cardinal TR, Wazlawik E, Bastos JL, et al. Standardized phase angle indicates nutritional status in hospitalized preoperative patients [J]. Nutr Res, 2010, 30(9): 594600.
20. Bozzetti F, SCRINIO Working Group. Screening the nutritional status in oncology: a preliminary report on 1 000 outpatients [J]. Support Care Cancer, 2009, 17(3): 279284.
21. 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(yíng)養(yǎng)風(fēng)險(xiǎn)、營(yíng)養(yǎng)不足、超重、肥胖及營(yíng)養(yǎng)支持狀況 [J]． 中華臨床營(yíng)養(yǎng)雜志, 2009, 17(2): 7578．.
22. 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.
23. Zhang YX, Wang SR. Distribution of body mass index and the prevalence changes of overweight and obesity among adolescents in Shandong, China from 1985 to 2005 [J]. Ann Hum Biol, 2008, 35(5): 547555.
24. Jiang ZM, Chen W, Zhan WH, et al. Parenteral and enteral nutrition application in west， middle and east China: A multicenter investigation for 15 098 patients in 13 metropolitans using Nutritional Risk Screening 2002 tool [J]. Clin Nutr, 2007, 2(Suppl 2): 133134.
25. 崔麗英, 張樹田, 于康, 等. 北京大醫(yī)院住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)、營(yíng)養(yǎng)不良(不足)、超重和肥胖發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況 [J]． 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 341345．.
  1. 1. 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 clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
  2. 2. Gur AS, Atahan K, Aladag I, et al. The efficacy of Nutrition Risk Screening2002 (NRS2002) to decide on the nutritional support in general surgery patients [J]. Bratisl Lek Listy, 2009, 110(5): 290292.
  3. 3. Kondrup J, Allison SP, Elia M, et al. ESPEN Guidelines for nutrition screening 2002 [J], Clin Nutr, 2003, 22 (4): 415421.
  4. 4. Raslan M, Gonzalez MC, Dias MC, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients [J]. Nutrition, 2010, 26(78): 721726.
  5. 5. 蔣朱明, 陳偉, 朱賽楠, 等. 我國(guó)東、中、西部大城市三甲醫(yī)院營(yíng)養(yǎng)不良(不足)、營(yíng)養(yǎng)風(fēng)險(xiǎn)發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況調(diào)查 [J]． 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 335337.
  6. 6. 蔣朱明, 于康, 朱賽楠, 等. 我國(guó)東中西部中小醫(yī)院住院患者營(yíng)養(yǎng)不足、營(yíng)養(yǎng)風(fēng)險(xiǎn)、超重和肥胖發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況調(diào)查 [J]. 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 338340.
  7. 7. 中華人民共和國(guó)衛(wèi)生部疾病控制司. 中國(guó)成人超重和肥胖癥預(yù)防控制指南 [M]. 北京: 人民衛(wèi)生出版社, 2006: 146.
  8. 8. Bruce RS, Blackburn GI， Joseph Vitale， et al． Prevalence of malnutrition in general medical patients [J]． JAMA, 1976, 235(4): 15671570.
  9. 9. Twomey C, Briet F, Jeejeebhoy KN. Adeverse effect of malnutrition on lymphocyte mitochondrialcomplex I activity in humans [J]. Clin Nutr, 1994,18（1）: 48.
  10. 10. van der Hulst RR, von Meyenfeldt MF, van Kreel BK, et al. Gut permeability, intestinal morphology, and nutritional depletion [J]. Nutrition, 1998, 14(1): 16.
  11. 11. 張明鳴, 周勇, 伍曉汀. 生長(zhǎng)激素短期應(yīng)用對(duì)胃腸外科手術(shù)后患者營(yíng)養(yǎng)狀況和血清IGF1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(12): 968973.
  12. 12. 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.
  13. 13. Burden ST, Hill J, Shaffer JL, et al. Nutritional status of preoperative colorectal cancer patients [J]. J Hum Nutr Diet， 2010, 23(4): 402407.
  14. 14. Caccialanza R, Klersy C, Cereda E, et al. Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients [J]. CMAJ, 2010, 182(17): 18431849.
  15. 15. 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.
  16. 16. 袁琮韋華, 李俊生, 嵇振嶺, 等. 全腸外營(yíng)養(yǎng)及早期腸內(nèi)營(yíng)養(yǎng)在胃癌全胃切除術(shù)后患者中的對(duì)比研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17（4）: 357362.
  17. 17. 中華醫(yī)學(xué)會(huì)． 住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查． 臨床診療指南腸外腸內(nèi)營(yíng)養(yǎng)學(xué)分冊(cè)(2008版) [M]． 北京: 人民衛(wèi)生出版社, 2009: 1620．.
  18. 18. Drescher T, Singler K, Ulrich A, et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients [J]. Eur J Clin Nutr, 2010, 64(8): 887893.
  19. 19. Cardinal TR, Wazlawik E, Bastos JL, et al. Standardized phase angle indicates nutritional status in hospitalized preoperative patients [J]. Nutr Res, 2010, 30(9): 594600.
  20. 20. Bozzetti F, SCRINIO Working Group. Screening the nutritional status in oncology: a preliminary report on 1 000 outpatients [J]. Support Care Cancer, 2009, 17(3): 279284.
  21. 21. 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(yíng)養(yǎng)風(fēng)險(xiǎn)、營(yíng)養(yǎng)不足、超重、肥胖及營(yíng)養(yǎng)支持狀況 [J]． 中華臨床營(yíng)養(yǎng)雜志, 2009, 17(2): 7578．.
  22. 22. 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.
  23. 23. Zhang YX, Wang SR. Distribution of body mass index and the prevalence changes of overweight and obesity among adolescents in Shandong, China from 1985 to 2005 [J]. Ann Hum Biol, 2008, 35(5): 547555.
  24. 24. Jiang ZM, Chen W, Zhan WH, et al. Parenteral and enteral nutrition application in west， middle and east China: A multicenter investigation for 15 098 patients in 13 metropolitans using Nutritional Risk Screening 2002 tool [J]. Clin Nutr, 2007, 2(Suppl 2): 133134.
  25. 25. 崔麗英, 張樹田, 于康, 等. 北京大醫(yī)院住院患者營(yíng)養(yǎng)風(fēng)險(xiǎn)、營(yíng)養(yǎng)不良(不足)、超重和肥胖發(fā)生率及營(yíng)養(yǎng)支持應(yīng)用狀況 [J]． 中國(guó)臨床營(yíng)養(yǎng)雜志, 2008, 16(6): 341345．.