老年营养风险指数在老年胃肠肿瘤围术期的应用

doi:10.16139/j.1007-9610.2021.01.012

摘要/Abstract

摘要：

目的：初步研究老年营养风险指数在老年胃肠肿瘤病人围术期的应用价值。方法：应用老年营养风险指数和营养风险筛查2002评估接受胃肠肿瘤手术老年病人（≥60岁）的营养风险。比较存在老年营养风险或营养风险的病人与无老年营养风险或无营养风险病人术后并发症发生及术后住院时间的差异。观察术前营养支持对两组术后并发症发生及术后住院时间的影响。结果：共纳入150例老年病人。老年营养风险发生率为60.00%（90/150）,营养风险发生率为40.67%（61/150）,Kappa值为0.062（P=0.415）。有老年营养风险者术后并发症发生率和术后住院时间分别为13.33%（12/90）和(10.37±4.66) d,与无风险者的23.33%（14/60)和(11.80±6.36) d相比,差异无统计学意义（P>0.05）。术前营养支持的老年营养风险病人术后并发症发生率和术后住院时间分别为6.38%(3/47)和(8.85±2.58) d,明显低于未接受营养支持者的20.93%(9/43)和(12.02±5.78) d（P<0.05）。有营养风险者术后并发症发生率和术后住院时间分别为13.11%(8/61)和(10.56±4.58) d,与无营养风险者的20.22%(18/89)和(11.20±5.95) d相比,差异无统计学意义（P>0.05）。术前营养支持的营养风险病人术后并发症发生率和术后住院时间分别为10.26%(4/39)和(10.03±4.94) d,与未接受营养支持者的18.19%(4/22)和(11.50±3.78) d相比,差异无统计学意义。结论：老年营养风险指数可用于老年胃肠肿瘤术前营养筛查,并作为术前营养支持的参考依据。

关键词: 老年营养风险指数, 营养风险筛查2002, 老年, 胃肠肿瘤

Abstract:

Objective To study the value of perioperative application of geriatric nutritional risk index (GNRI) in elderly patients with gastrointestinal tumor. Methods GNRI or nutritional risk screening 2002 (NRS 2002) was used to eva-luate the nutritional risk in elderly patients (≥60 years old) with gastrointestinal tumor surgery. Both operative complications and postoperative hospital stay in elderly patients with geriatric nutritional risk or nutritional risk were compared with those without geriatric nutritional risk or nutritional risk. The effect of preoperative nutritional support on operative complications and postoperative hospital stay in two groups was studied. Results A total of 150 elderly patients were enrolled. Geriatric nutritional risk and nutritional risk in the patients was predicted at 60.00%(90/150) and 40.67%(61/150) respectively. The Kappa value was 0.062 (P=0.415). Operative complication rate in the patients with geriatric nutritional risk was 13.33% (12/90) and postoperative hospital stay (10.37±4.66) days without significant difference (P>0.05) when compared with those [23.33% (14/60), (11.80±6.36) days] in the patients without geriatric nutritional risk. Preoperative nutritional support decreased operative complications 6.38% (3/47) and length of postoperative stay (8.85±2.58) days in geriatric nutritional risk patients compared with those [20.93% (9/43), (12.02±5.78) days] without preoperative nutritional support (P<0.05). No significant difference was present between operative complications [13.11% (8/61)] and length of postoperative stay [(10.56±4.58) days] in the patients with nutritional risk and [20.22% (18/89), (11.20±5.95) days] in the patients without nutritional risk (P>0.05), and between [10.26% (4/39), (10.03±4.94) days] in nutritional risk patients with preoperative nutritional support and [18.19% (4/22), (11.50±3.78) days] in those without preoperative nutritional support (P>0.05). Conclusion GNRI could be used to screen the nutritional risk of the patients with gastrointestinal tumors before operation, and used as a reference for preoperative nutritional support.

Key words: Geriatric nutrition risk index, Nutrition risk screening 2002, Elderly, Gastrointestinal tumor

中图分类号:

李梅, 邱文才, 高琦, 杨俊, 贾震易. 老年营养风险指数在老年胃肠肿瘤围术期的应用[J]. 外科理论与实践, 2021, 26(01): 58-61.

LI Mei, QIU Wencai, GAO Qi, YANG Jun, JIA Zhenyi. Perioperative application of geriatric nutritional risk index in senile patients with gastrointestinal tumors[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 58-61.

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参考文献 12

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项目	GNRI≤98(n=90)	GNRI >98(n=60)	合计
NRS 2002≥3	39(43.33)	22(36.67)	61(40.67)
NRS 2002<3	51(56.67)	38(63.33)	89(59.33)
合计	90(60.00）	60(40.00)	150

项目	GNRI≤98(n=37)	GNRI >98(n=19)	合计
NRS 2002≥3	37(100)	19(100)	56(100)
NRS 2002<3	0	0	0
合计	37(66.07）	19(33.93)	56

项目	GNRI评价			NRS 2002评价
项目	有风险	无风险	P值	有风险	无风险	P值
并发症发生（%）	12/90(13.33)	14/60(23.33)	0.113	8/61(13.11)	18/89(20.22)	0.258
术后住院时间（d）	10.37±4.66	11.80±6.36	0.114	10.56±4.58	11.20±5.95	0.480

项目		GNRI评价			NRS 2002评价
项目		有风险（90）	无风险（60）	P值	有风险（61）	无风险（89）	P值
性别	男	52	34		34	52
	女	38	26	0.893	27	37	0.744
年龄		70.06±8.65	66.98±6.03	0.017 8	76.30±6.80	63.70±2.75	<0.000 1
疾病种类	结肠直肠肿瘤	58	45		46	57
	胃肿瘤	31	13		15	29
	小肠肿瘤	1	2	0.176	0	3	0.137
手术方式	腹腔镜	42	31		31	4 229
	开放	48	29	0.548	30	47	0.662
手术时间（min）		166.19±55.94	163.40±54.66	0.763 1	170.84±60.73	157.80±43.08	0.126 0
术前营养支持(%)	有	47（52.22）	29（48.33）		39（63.93）	37（41.57）
	无	43（47.78）	31（51.67）	0.641	22（36.07）	52（58.43）	0.007
营养支持类型	肠内	29	17		26	21
	肠外	8	4		5	7
	肠外+肠内	10	8	0.799	8	9	0.647
BMI		22.76±3.58	24.15±2.85	0.0128	23.53±3.50	23.01±3.16	0.345 0
血清白蛋白（g/L）		33.00±4.07	41.92±2.80	<0.000 1	35.13±6.00	37.55±5.25	0.010 7

项目	有老年营养风险者			无老年营养风险者
项目	术前支持	无支持	P值	术前支持	无支持	P值
并发症发生（%）	3/47(6.38)	9/43(20.93)	0.043	6/29(20.69)	8/31(25.81)	0.640
术后住院时间（d）	8.85±2.58	12.02±5.78	0.001	11.93±6.18	11.68±6.62	0.881