Nutritional risk screening among patients in department of gastrointestinal surgery and effectiveness of perioperative nutrition support on recovery of gastric cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Zhongkai ¹ , SUN Shaochuan ¹ , XUE Yiheng ²

1. Department of Gastrointestinal Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan 250000, P.R.China;
2. Medical College of Shandong University, Jinan 250000, P.R.China;

Corresponding?author：

XU Zhongkai, Email: xzk1981922@163.com

Keywords：

nutritional risk; nutrition support; department of gastrointestinal surgery; gastric cancer

DOI：

10.7507/1007-9424.201611054

Video：

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Objective To explore the status of nutrition risk and its relative factors in patients of department of gastrointestinal surgery, and to observe the effectiveness of nutrition support on post-operative recovery of patients with gastric cancer. Methods A total of 1 048 cases of in-patients in Department of Gastrointestinal Surgery of Jinan Central Hospital Affiliated Shandong University from January 2015 to January 2016 were collected prospectively, and then screened the nutrition risk of these patients by nutritional risk screening 2002 (NRS-2002) and evaluated the actual malnutrition situation when they left hospital. Then collected 52 gastric cancer patients whose NRS-2002 score ≥3, and divided them to control group and experimental group randomly. The patients of experimental group received extra standard medical nutrition support while the patients of control group did not. Compared the nutritional indexes as well as some postoperative recovery indexes, such as the postoperative exhaust time, postoperative defecation time, infusion stop time, length of hospital stay, and incidence of complications. Results ① Nutritional risk. Among the 1 048 cases, 230 cases (21.9%) had nutritional risk while 118 cases (11.3%) developed to malnutrition. Age and degree of cancer were all related with nutritional risk (P<0.05) while gender was irrelevant (P>0.05). Patients with age ≥60 years, advanced gastric cancer, and colorectal cancer in Ⅲ+Ⅳ staging, had higher rates of nutritional risk than patients with age <60 years, early gastric cancer, and colorectal cancer inⅠ+Ⅱstaging. Results of actual malnutrition was in good accordance with the screening result of NRS-2002 (κ=0.57). ② Influence of nutritional support on gastric cancer patients. Compared with control group, there was an improvement in albumin, pre-albumin, and weight of experimental group and the distinction had statistical significance (P<0.05). The distinction of postoperative exhaust time and incidence of complication between the two groups were not statistically significant (P>0.05), but postoperative defecation time, infusion stop time, and the length of hospital stay of the experimental group were shorter than those of the control group with statistical significance (P<0.05). Conclusions The problem of malnutrition exists generally in the in-patients of department of gastrointestinal surgery. Applying the instrument of nutritional risk assessment to assess the risk as early as possible and giving appropriate nutrition support therapy positively, will make favorable influence to the prognosis of gastric cancer patients.

Citation： XU Zhongkai, SUN Shaochuan, XUE Yiheng. Nutritional risk screening among patients in department of gastrointestinal surgery and effectiveness of perioperative nutrition support on recovery of gastric cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(7): 837-842. doi: 10.7507/1007-9424.201611054 Copy

1.	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
2.	Hartman C, Shamir R, Hecht C, et al. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care, 2012, 15(3): 303-309.
3.	金迪, 蔡東聯. 危重病人的營養治療. 藥學服務與研究, 2008, 8(2): 142-145.
4.	蔣朱明, 陳偉, 朱賽楠, 等. 我國東、中、西部大城市三甲醫院營養不良(不足)、營養風險發生率及營養支持應用狀況調查. 中國臨床營養雜志, 2008, 16(6): 335-337.
5.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
6.	Charney P. Nutrition screening vs nutrition assessment: how do they differ? Nutr Clin Pract, 2008, 23(4): 366-372.
7.	Laporte M, Villalon L, Thibodeau J, et al. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging, 2001, 5(4): 292-294.
8.	Corish CA, Kennedy NP. Protein-energy undernutrition in hospital in-patients. Br J Nutr, 2000, 8(3): 575-591.
9.	潘美珍, 陳聿華, 唐佳婉, 等. 呼吸科住院患者營養狀況和疾病負擔調查分析. 中國初級衛生保健, 2017, 31(1): 49-51.
10.	毛志音, 陳惠斌, 曾田荷, 等. 317 例食管癌患者術前營養風險分析. 現代腫瘤醫學, 2016, 24(23): 3743-3745.
11.	李素云, 喻姣花, 曾莉, 等. 住院患者營養風險篩查及營養支持狀況分析. 護理學雜志, 2016, 31(21): 99-102.
12.	孫大力, 徐鵬遠, 岑云云, 等. 昆明地區某三甲醫院普通外科住院手術患者營養情況調查. 重慶醫學, 2016, 45(34): 4830-4833.
13.	陳偉, 蔣朱明, 張永梅, 等. 歐洲營養不良風險調查方法在中國住院病人的臨床可行性研究. 中華臨床營養雜志, 2005, 13(3): 137-141.
14.	左傳麗. 應用 NRS2002 標準調查腹部外科病人的營養狀況及營養支持. 全科護理, 2012, 10(13): 1235-1236.
15.	王楠, 王玉梅, 劉雪梅, 等, 住院患者營養風險、營養不良發生率及營養現狀的評估分析. 職業與健康, 2013, 29(19): 2424-2426.
16.	張靜, 陳格亮, 花超, 等. 內科老年患者營養風險篩查及營養支持使用情況分析. 世界臨床藥物, 2013, 34(6): 356-358.
17.	龐冬, 鄭凡凡, 周玉潔, 等. 普通外科住院病人術前營養風險、營養支持和醫師相關知識的調查分析. 腸外與腸內營養, 2010, 17(2): 65-68.
18.	段紀俊, 嚴亞瓊, 楊念念, 等. 中國惡性腫瘤發病與死亡的國際比較分析. 中國醫學前沿雜志(電子版), 2016, 8(7): 17-23.
19.	潘玲, 毛德強. RS-2002 評估 473 例首診惡性腫瘤患者營養狀況. 重慶醫學, 2013, 42(10): 1117-1121.
20.	曾滿萍. 晚期腫瘤患者的營養支持治療. 中國腫瘤臨床與康復, 2008, 15(5): 472-473.
21.	Huhmann MB, Cunningham RS. Importance of nutritional screening in treatment of cancer-related weight loss. Lancet Oncol, 2005, 6(5): 334-343.
22.	楊振淮, 李關寧. 胃腸道惡性腫瘤患者圍手術期腸內營養支持的療效分析. 實用全科醫學, 2008, 6(5): 483-484.
23.	von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs, 2005, 9 Suppl 2: S35-S38.
24.	Akbulut G. New perspective for nutritional support of cancer patients: enteral/parenteral nutrition. Exp Ther Med, 2011, 2(4): 675-684.
25.	武杰, 黃靜. 營養風險篩查 (NRS2002) 在胃腸道腫瘤患者中的應用. 中國現代普通外科進展, 2012, 15(4): 331-332.
26.	Bozzetti F, Gavazzi C, Miceli R, et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr, 2000, 24(1): 7-14.
27.	陳淑紅, 唐有為. 歐洲營養風險篩查方法在消化內科住院病人的應用. 腸外與腸內營養, 2010, 17(4): 221-223.
28.	戴福仁, 趙新新, 董素蓮. 腫瘤內科住院患者營養風險篩查及營養支持應用狀況. 現代實用醫學, 2010, 22(6): 617-619.
29.	余雪梅, 曾凱宏, 劉力, 等. 普通外科住院病人營養風險篩查和營養支持應用狀況. 腸外與腸內營養, 2011, 18(4): 238-240.

1. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
2. Hartman C, Shamir R, Hecht C, et al. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care, 2012, 15(3): 303-309.
3. 金迪, 蔡東聯. 危重病人的營養治療. 藥學服務與研究, 2008, 8(2): 142-145.
4. 蔣朱明, 陳偉, 朱賽楠, 等. 我國東、中、西部大城市三甲醫院營養不良(不足)、營養風險發生率及營養支持應用狀況調查. 中國臨床營養雜志, 2008, 16(6): 335-337.
5. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr, 2003, 22(3): 321-336.
6. Charney P. Nutrition screening vs nutrition assessment: how do they differ? Nutr Clin Pract, 2008, 23(4): 366-372.
7. Laporte M, Villalon L, Thibodeau J, et al. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging, 2001, 5(4): 292-294.
8. Corish CA, Kennedy NP. Protein-energy undernutrition in hospital in-patients. Br J Nutr, 2000, 8(3): 575-591.
9. 潘美珍, 陳聿華, 唐佳婉, 等. 呼吸科住院患者營養狀況和疾病負擔調查分析. 中國初級衛生保健, 2017, 31(1): 49-51.
10. 毛志音, 陳惠斌, 曾田荷, 等. 317 例食管癌患者術前營養風險分析. 現代腫瘤醫學, 2016, 24(23): 3743-3745.
11. 李素云, 喻姣花, 曾莉, 等. 住院患者營養風險篩查及營養支持狀況分析. 護理學雜志, 2016, 31(21): 99-102.
12. 孫大力, 徐鵬遠, 岑云云, 等. 昆明地區某三甲醫院普通外科住院手術患者營養情況調查. 重慶醫學, 2016, 45(34): 4830-4833.
13. 陳偉, 蔣朱明, 張永梅, 等. 歐洲營養不良風險調查方法在中國住院病人的臨床可行性研究. 中華臨床營養雜志, 2005, 13(3): 137-141.
14. 左傳麗. 應用 NRS2002 標準調查腹部外科病人的營養狀況及營養支持. 全科護理, 2012, 10(13): 1235-1236.
15. 王楠, 王玉梅, 劉雪梅, 等, 住院患者營養風險、營養不良發生率及營養現狀的評估分析. 職業與健康, 2013, 29(19): 2424-2426.
16. 張靜, 陳格亮, 花超, 等. 內科老年患者營養風險篩查及營養支持使用情況分析. 世界臨床藥物, 2013, 34(6): 356-358.
17. 龐冬, 鄭凡凡, 周玉潔, 等. 普通外科住院病人術前營養風險、營養支持和醫師相關知識的調查分析. 腸外與腸內營養, 2010, 17(2): 65-68.
18. 段紀俊, 嚴亞瓊, 楊念念, 等. 中國惡性腫瘤發病與死亡的國際比較分析. 中國醫學前沿雜志(電子版), 2016, 8(7): 17-23.
19. 潘玲, 毛德強. RS-2002 評估 473 例首診惡性腫瘤患者營養狀況. 重慶醫學, 2013, 42(10): 1117-1121.
20. 曾滿萍. 晚期腫瘤患者的營養支持治療. 中國腫瘤臨床與康復, 2008, 15(5): 472-473.
21. Huhmann MB, Cunningham RS. Importance of nutritional screening in treatment of cancer-related weight loss. Lancet Oncol, 2005, 6(5): 334-343.
22. 楊振淮, 李關寧. 胃腸道惡性腫瘤患者圍手術期腸內營養支持的療效分析. 實用全科醫學, 2008, 6(5): 483-484.
23. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs, 2005, 9 Suppl 2: S35-S38.
24. Akbulut G. New perspective for nutritional support of cancer patients: enteral/parenteral nutrition. Exp Ther Med, 2011, 2(4): 675-684.
25. 武杰, 黃靜. 營養風險篩查 (NRS2002) 在胃腸道腫瘤患者中的應用. 中國現代普通外科進展, 2012, 15(4): 331-332.
26. Bozzetti F, Gavazzi C, Miceli R, et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr, 2000, 24(1): 7-14.
27. 陳淑紅, 唐有為. 歐洲營養風險篩查方法在消化內科住院病人的應用. 腸外與腸內營養, 2010, 17(4): 221-223.
28. 戴福仁, 趙新新, 董素蓮. 腫瘤內科住院患者營養風險篩查及營養支持應用狀況. 現代實用醫學, 2010, 22(6): 617-619.
29. 余雪梅, 曾凱宏, 劉力, 等. 普通外科住院病人營養風險篩查和營養支持應用狀況. 腸外與腸內營養, 2011, 18(4): 238-240.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Nutritional risk screening among patients in department of gastrointestinal surgery and effectiveness of perioperative nutrition support on recovery of gastric cancer patients

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