术前营养状况与结直肠癌手术患者临床结局的相关性研究

发布时间：2018-04-29 17:19

  本文选题：结直肠癌 + 营养风险　； 参考：《大连医科大学》2017年硕士论文

【摘要】：背景:结直肠癌属于全世界范围内比较常见的一种恶性肿瘤,而且随着近年来我国社会的发展进步,结直肠癌在我国的发病率及死亡率在不断增长。对于发病率及死亡率都日益增长的结直肠癌来说,手术切除是最主要的治疗方式。许多研究证明术前患者营养状况往往会影响到患者术后恢复情况,而结直肠癌患者入院前,其中相当一部分的患者处于不同程度的营养不良的状态,需要对其营养状态进行改善。目的:分析术前营养状况与结直肠癌手术患者临床结局的相关性。方法:对山东省青岛市市立医院东院区普外二病区单一医疗组在2014年9月至2016年9月期间,限期行结直肠癌根治术的146例结直肠癌患者进行回顾性系统调查研究。运用NRS 2002对患者术前的营养状况进行营养风险评估筛查,分析结直肠癌患者术前营养状况与术后临床结局的相关性的联系。按照NRS 2002标准对患者术前营养状况进行营养风险评估分组(A组具有营养风险组;B组无营养风险组).结果:根据NRS 2002评分,有64例(43.84%)患者无营养风险(NRS 2002评分3分),有82例(56.16%)患者具有营养风险(NRS 2002评分≥3分)。入组患者中年龄分组:年龄≥70岁的40例,年龄70岁的106例;合并症分组:合并肠梗阻的有17例;术前血红蛋白(男120g/L女110g/L)的23例;术前血清白蛋白35g/L的14例。其中年龄≥70岁(P0.001)、合并肠梗阻(P=0.021,P0.05)、血红蛋白(男120g/L 女110g/L)(P=0.02,P0.05)、血清白蛋白35g/L(P=0.004,P0.05)属于影响营养状况的相关性因素,P0.05具有统计学意义。术前具有营养风险(NRS 2002≥3分)的结直肠癌患者组术后发生并发症的人数占入选营养风险组患者总人数的28.05%;术前无营养风险(NRS 20023分)的结直肠癌患者组术后发生并发症的人数占入选无营养风险组患者总人数的12.5%。相比较于营养风险组,无营养风险组术后并发症发生率相对更低,且差距有统计学意义(P=0.002,P0.05)。而且营养风险组患者的住院时间明显多于无营养风险组的住院时间,且t=2.416,p= 0.02,p0.05,有统计学意义。营养风险组的肛门排气时间明显多于无营养风险组的肛门排气时间,且t=3.033,p= 0.04,p0.05,有统计学意义。结论:在结直肠癌患者中,术前合并肠梗阻、年龄≥70岁、术前血红蛋白(男120g/L女110g/L)、术前血清白蛋白35g/L的这一类结直肠癌患者更容易出现营养风险;具有营养风险(NRS 2002评分≥3分)的结直肠癌患者组术后更容易出现并发症且出院时间及肛门排气时间都会相对延长,因此对于具有营养风险(NRS 2002评分≥3分)的结直肠癌患者需要改善其术前的营养状况,以减少不良的临床结局的发生。
[Abstract]:Background: colorectal cancer is one of the most common malignant tumors in the world. With the development of our society in recent years, the morbidity and mortality of colorectal cancer in China are increasing. Surgical resection is the most important treatment for colorectal cancer, where morbidity and mortality are increasing. Many studies have shown that preoperative nutritional status often affects postoperative recovery, whereas before admission to hospital for colorectal cancer, a significant proportion of these patients are in varying degrees of malnutrition. Their nutritional status needs to be improved. Objective: to analyze the relationship between preoperative nutritional status and clinical outcome of colorectal cancer patients. Methods: from September 2014 to September 2016, 146 patients with colorectal cancer underwent radical resection of colorectal cancer were studied retrospectively. NRS 2002 was used to screen the nutritional risk of the patients before operation and to analyze the relationship between preoperative nutritional status and postoperative clinical outcome in patients with colorectal cancer. According to NRS 2002 standard, the nutritional risk assessment of patients before operation was carried out in group A with nutritional risk group and group B with no nutritional risk group. Results: according to the NRS 2002 score, there were 64 patients with no nutritional risk and 32 patients with NRS 2002 score (3 points) and 82 patients with nutritional risk (NRS 2002 score 鈮，

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