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, 蔡东联. 危重病人的营养治疗. 药学服务与研究, 2008, 8(2): 142-145.
4.	蒋朱明, 陈伟, 朱赛楠, 等. 我国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查. 中国临床营养杂志, 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, 陈聿华, 唐佳婉, 等. 呼吸科住院患者营养状况和疾病负担调查分析. 中国初级卫生保健, 2017, 31(1): 49-51.
10.	毛志音, 陈惠斌, 曾田荷, 等. 317 例食管癌患者术前营养风险分析. 现代肿瘤医学, 2016, 24(23): 3743-3745.
11.	李素云, 喻姣花, 曾莉, 等. 住院患者营养风险筛查及营养支持状况分析. 护理学杂志, 2016, 31(21): 99-102.
12.	孙大力, 徐鹏远, 岑云云, 等. 昆明地区某三甲医院普通外科住院手术患者营养情况调查. 重庆医学, 2016, 45(34): 4830-4833.
13.	陈伟, 蒋朱明, 张永梅, 等. 欧洲营养不良风险调查方法在中国住院病人的临床可行性研究. 中华临床营养杂志, 2005, 13(3): 137-141.
14.	左传丽. 应用 NRS2002 标准调查腹部外科病人的营养状况及营养支持. 全科护理, 2012, 10(13): 1235-1236.
15.	王楠, 王玉梅, 刘雪梅, 等, 住院患者营养风险、营养不良发生率及营养现状的评估分析. 职业与健康, 2013, 29(19): 2424-2426.
16.	张静, 陈格亮, 花超, 等. 内科老年患者营养风险筛查及营养支持使用情况分析. 世界临床药物, 2013, 34(6): 356-358.
17.	庞冬, 郑凡凡, 周玉洁, 等. 普通外科住院病人术前营养风险、营养支持和医师相关知识的调查分析. 肠外与肠内营养, 2010, 17(2): 65-68.
18.	段纪俊, 严亚琼, 杨念念, 等. 中国恶性肿瘤发病与死亡的国际比较分析. 中国医学前沿杂志(电子版), 2016, 8(7): 17-23.
19.	潘玲, 毛德强. RS-2002 评估 473 例首诊恶性肿瘤患者营养状况. 重庆医学, 2013, 42(10): 1117-1121.
20.	曾满萍. 晚期肿瘤患者的营养支持治疗. 中国肿瘤临床与康复, 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.	杨振淮, 李关宁. 胃肠道恶性肿瘤患者围手术期肠内营养支持的疗效分析. 实用全科医学, 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, 黄静. 营养风险筛查 (NRS2002) 在胃肠道肿瘤患者中的应用. 中国现代普通外科进展, 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.	陈淑红, 唐有为. 欧洲营养风险筛查方法在消化内科住院病人的应用. 肠外与肠内营养, 2010, 17(4): 221-223.
28.	戴福仁, 赵新新, 董素莲. 肿瘤内科住院患者营养风险筛查及营养支持应用状况. 现代实用医学, 2010, 22(6): 617-619.
29.	余雪梅, 曾凯宏, 刘力, 等. 普通外科住院病人营养风险筛查和营养支持应用状况. 肠外与肠内营养, 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, 蔡东联. 危重病人的营养治疗. 药学服务与研究, 2008, 8(2): 142-145.
4. 蒋朱明, 陈伟, 朱赛楠, 等. 我国东、中、西部大城市三甲医院营养不良(不足)、营养风险发生率及营养支持应用状况调查. 中国临床营养杂志, 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, 陈聿华, 唐佳婉, 等. 呼吸科住院患者营养状况和疾病负担调查分析. 中国初级卫生保健, 2017, 31(1): 49-51.
10. 毛志音, 陈惠斌, 曾田荷, 等. 317 例食管癌患者术前营养风险分析. 现代肿瘤医学, 2016, 24(23): 3743-3745.
11. 李素云, 喻姣花, 曾莉, 等. 住院患者营养风险筛查及营养支持状况分析. 护理学杂志, 2016, 31(21): 99-102.
12. 孙大力, 徐鹏远, 岑云云, 等. 昆明地区某三甲医院普通外科住院手术患者营养情况调查. 重庆医学, 2016, 45(34): 4830-4833.
13. 陈伟, 蒋朱明, 张永梅, 等. 欧洲营养不良风险调查方法在中国住院病人的临床可行性研究. 中华临床营养杂志, 2005, 13(3): 137-141.
14. 左传丽. 应用 NRS2002 标准调查腹部外科病人的营养状况及营养支持. 全科护理, 2012, 10(13): 1235-1236.
15. 王楠, 王玉梅, 刘雪梅, 等, 住院患者营养风险、营养不良发生率及营养现状的评估分析. 职业与健康, 2013, 29(19): 2424-2426.
16. 张静, 陈格亮, 花超, 等. 内科老年患者营养风险筛查及营养支持使用情况分析. 世界临床药物, 2013, 34(6): 356-358.
17. 庞冬, 郑凡凡, 周玉洁, 等. 普通外科住院病人术前营养风险、营养支持和医师相关知识的调查分析. 肠外与肠内营养, 2010, 17(2): 65-68.
18. 段纪俊, 严亚琼, 杨念念, 等. 中国恶性肿瘤发病与死亡的国际比较分析. 中国医学前沿杂志(电子版), 2016, 8(7): 17-23.
19. 潘玲, 毛德强. RS-2002 评估 473 例首诊恶性肿瘤患者营养状况. 重庆医学, 2013, 42(10): 1117-1121.
20. 曾满萍. 晚期肿瘤患者的营养支持治疗. 中国肿瘤临床与康复, 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. 杨振淮, 李关宁. 胃肠道恶性肿瘤患者围手术期肠内营养支持的疗效分析. 实用全科医学, 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, 黄静. 营养风险筛查 (NRS2002) 在胃肠道肿瘤患者中的应用. 中国现代普通外科进展, 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. 陈淑红, 唐有为. 欧洲营养风险筛查方法在消化内科住院病人的应用. 肠外与肠内营养, 2010, 17(4): 221-223.
28. 戴福仁, 赵新新, 董素莲. 肿瘤内科住院患者营养风险筛查及营养支持应用状况. 现代实用医学, 2010, 22(6): 617-619.
29. 余雪梅, 曾凯宏, 刘力, 等. 普通外科住院病人营养风险筛查和营养支持应用状况. 肠外与肠内营养, 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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