消化系统恶性肿瘤患者围手术期能量代谢的研究

发布时间：2018-10-29 16:03

【摘要】：目的:探讨消化系统恶性肿瘤患者围手术期能量代谢及营养状况的变化,为理想的疼痛管理提供参考。方法:选取上海瑞金医院普外科住院接受消化系统恶性肿瘤手术治疗患者,术前运用Harris-Benedict公式(H-B公式)估算静息能量消耗(resting energy expenditure,REE);围手术期监测血清白蛋白(albumin,Alb)、血清前白蛋白(prealbumin,PAlb)等指标;运用Quark RMR能量代谢监测系统进行围手术期静息能量消耗和呼吸熵(respiratory quotient,RQ)。另设健康对照组,评价Quark RMR能量代谢监测系统的准确性及可靠性,比较健康人群REE、RQ与消化系统恶性肿瘤患者术前REE、RQ的差异;分析消化系统恶性肿瘤患者围手术期REE、RQ、Alb、PAlb的变化情况;比较不同手术方式对患者术后REE、RQ及营养状态的影响;分析围手术期疼痛管理、术后疼痛程度与围手术期REE的关系。结果:实际纳入健康受试者10例,消化系统恶性肿瘤患者33例。在REE监测方面,Quark RMR的实测值接近H-B公式的估测值(p0.05)。消化系统恶性肿瘤患者术前REE较健康人群升高(p0.05),术前RQ则低于健康人群(p0.05)。术后第2天REE较术前明显升高(p0.05),术后第5天REE较术后初期有所下降,接近术前水平,但仍略高于术前(p0.05);术后第2天RQ较术前明显降低(p0.05),术后第5天RQ则稍低于术前水平(p0.05);开放性手术组的变化幅度略大于腹腔镜手术组。术后第1天Alb水平较术前降低(p0.05),但术后第4天Alb已完全恢复(p0.05);术后PAlb水平较术前进行性下降,且下降幅度明显(p0.05);手术方式对Alb及PAlb的变化无明显影响。术中镇痛药物的用量与术前REE无特定关系;术后REE水平与疼痛程度呈正相关,良好的术后镇痛有助于患者术后恢复。结论:Quark RMR能量代谢监测系统操作简便、结果可靠。患者的基础状况、手术方式、营养状况、疼痛程度等均对消化系统恶性肿瘤患者围手术期能量代谢存在影响。监测围手术期能量代谢情况和营养状况,对评估患者基础状况、制定合理的治疗方案及疼痛管理方案均有重要意义,有利于患者术后恢复。
[Abstract]:Objective: to investigate the changes of energy metabolism and nutritional status in patients with malignant tumors of digestive system during perioperative period. Methods: the patients in general surgery department of Shanghai Ruijin Hospital were selected for surgical treatment of malignant tumors of digestive system. Harris-Benedict formula (H-B formula) was used to estimate the resting energy consumption (resting energy expenditure,REE) before operation. Serum albumin (albumin,Alb) and serum prealbumin (prealbumin,PAlb) were monitored during perioperative period and resting energy consumption and respiratory entropy (respiratory quotient,RQ) were measured by Quark RMR energy metabolism monitoring system. The accuracy and reliability of Quark RMR energy metabolism monitoring system were evaluated in a healthy control group, and the difference of REE,RQ before operation between healthy people and patients with digestive system malignant tumor was compared. To analyze the changes of REE,RQ,Alb,PAlb in patients with malignant tumors of digestive system during perioperative period, to compare the effect of different operation methods on REE,RQ and nutritional status of patients after operation. To analyze the relationship between perioperative pain management, postoperative pain degree and perioperative REE. Results: 10 healthy subjects and 33 patients with malignant tumors of digestive system were included. In terms of REE monitoring, the measured value of, Quark RMR was close to the estimated value of H-B formula (p0.05). The preoperative REE of patients with digestive system malignant tumor was higher than that of healthy people (p0.05), but the preoperative RQ was lower than that of healthy people (p0.05). On the second day after operation, REE was significantly higher than that before operation (p0. 05). On the 5th day after operation, the level of REE was lower than that before operation, which was close to the preoperative level, but still slightly higher than that before operation (p0. 05). On the second day after operation, RQ was significantly lower than that before operation (p0.05), and on the 5th day after operation, the level of RQ was slightly lower than that before operation (p0.05), and the range of changes in open operation group was slightly larger than that in laparoscopic operation group. On the first day after operation, the level of Alb was lower than that before operation (p0.05), but on the 4th day after operation, the level of Alb recovered completely (p0.05), and the level of PAlb decreased progressively after operation (p0.05). The changes of Alb and PAlb were not affected by the operation method. There was no specific relationship between the dosage of intraoperative analgesic drugs and preoperative REE, but there was a positive correlation between postoperative REE level and the degree of pain. Good postoperative analgesia was helpful to the recovery of postoperative patients. Conclusion: Quark RMR energy metabolism monitoring system is simple and reliable. The basic condition, operation mode, nutritional status and pain degree of patients with malignant tumors of digestive system have influence on energy metabolism in perioperative period. Monitoring the energy metabolism and nutritional status in perioperative period is of great significance to evaluate the patients' basic condition and to formulate reasonable treatment and pain management plan, which is beneficial to the postoperative recovery of patients.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R614;R735

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