基于GLIM标准诊断营养不良的老年病人腹部手术后肠内、肠外营养支持的比较研究

doi:10.16139/j.1007-9610.2024.06.08

摘要/Abstract

摘要：

目的： 观察经GLIM标准诊断为营养不良的老年腹部手术后病人采取肠内与肠外营养支持方式在术后并发症、肛门排气时间、免疫功能、疲劳指数等的影响。方法： 先用全球营养领导层营养不良倡议（GLIM）两步骤诊断90例老年（≥70岁）腹部手术病人为营养不良；术后随机分为肠内营养（EN）组和肠外营养（PN）组。术后第1及第7天检测相应的免疫和疲劳指数，观察术后并发症、肛门排气时间及平均住院时间，且予以比较和分析。结果： 老年腹部手术病人的营养风险发生率为61.0%（122/200）,营养不良发生率为45.0%（90/200）。术后第7天EN组IgA、IgM、IgG以及CD3、CD4和CD4/CD8的含量较PN组显著增多（P<0.05)。术后EN组较PN组发生术后并发症显著减少（P<0.05)，肛门排气时间及住院时间显著缩短（P<0.05)。EN组术后第7天疲劳指数计分明显优于PN组(P<0.05)。结论： 基于GLIM对老年病人营养不良的诊断是进行营养干预的必要前提。早期运用EN，可减少老年病人术后并发症发生和住院时间，改善术后疲劳综合征和免疫状态，改善营养不良病人术后康复。

关键词: 营养支持, 营养不良, 老年腹部手术病人, 全球营养领导层营养不良倡议

Abstract:

Objective To observe the effects of postoperative complications, anal exhaust time, immune function and fatigue index of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria. Methods Ninty elderly abdominal surgery patients (more than 70 years old) who diagnosed as malnutrition by GLIM 2-step method were divided into enteral nutrition(EN) group and parenteral nutrition (PN) group randomly. The corresponding immune and fatigue indexes were tested on day 1 and day 7 of postoperation. Postoperative complications, anal exhaust time and mean time of hospitalization were observed and analyzed. Results The incidence of malnutritional risk was 61.0% (122/200) in elderly abdominal surgery patients and malnutrition incidence was 45.0% (90/200). IgA, IgM, IgG, CD3, CD4 and CD4/CD8 on postoperative day 7 increased significantly in EN group than those in PN group (P<0.05). The postoperative complications in EN group significantly lower than that in PN group (P<0.05). Anus exhaust time and hospitalization days of EN group were shorter than that of PN group (P<0.05). Fatigue index on postoperative day 7 of EN group was significantly better than that of PN group (P<0.05). Conclusions The malnutrition diagnosis of elderly patients based on GLIM crteria is a necessary prerequisite for nutritional intervention. Early EN support can reduce postoperative complications and hospitalization days in elderly patients, improve postoperative fatigue syndrome and immune status, and improve the patients with malnutrition recover from surgery.

Key words: Nutritional support, Malnutrition, Elderly abdominal surgery patient, Global leadership initiative on malnutrition(GLIM)

中图分类号:

R656
R459.3

蔡卓玮, 朱登峰, 陈明干, 蔡一亭, 陈大伟, 高铭. 基于GLIM标准诊断营养不良的老年病人腹部手术后肠内、肠外营养支持的比较研究[J]. 外科理论与实践, 2024, 29(06): 503-509.

CAI Zhuowei, ZHU Dengfeng, CHEN Minggan, CAI Yiting, CHEN Dawei, GAO Ming. Comparative study of parenteral and enteral nutrition support after abdominal surgery in elderly patients with malnutrition diagnosed by GLIM criteria[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 503-509.

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Item	Cases	Cases of nutrition risk	χ² value	P value
Gender			0.014	>0.05
Male	117	72（61.5%）
Female	83	50（60.2%）
Age group			0.120	>0.05
70-79	140	87（62.1%）
80-85	60	35（58.3%）
Total	200	122（61.0%）

Item		Disease of biliary tract (n=12)	Gastrointestinal disease (n=78)	Total (n=90)	χ² value	P value
Phenotypic criteria	Loss of weight	9	60	69(76.7%)	0.021	0.883
Phenotypic criteria	Low BMI	6	41	47(52.2%)	0.027	0.869
The etiology of the standard	Feeding reduction or digestive dysfunction	11	75	86(95.6%)	0.493	0.483
The etiology of the standard	Inflammatory status / disease burden	12	78	90(100%)	/	/

Item	EN group(n=45)	PN group(n=45)	t/χ² value	P value
Age (year)	75.5±6.5	76.8±7.2	-0.899	0.371
Gender (male / female)	21/24	20/25	0.045	0.832
weight (kg)	68.4±7.1	69.3±6.7	-0.618	0.538
Minimally invasive / open surgery	0.371	0.832	0.538	0.796
Malignant / benign disease	10/35	9/36	0.067	0.796
Emergency / elective	32/13	33/12	0.055	0.814

Item		EN group（n=45）	PN group（n=45）	total	χ² value	P value
Anastomotic leakage	Operation on biliary tract	0	1（1.1%）	1	/	/
Anastomotic leakage	Gastrointestinal surgery	2（2.2%）	5（5.5%）	7	/	/
Pulmonary infection	Operation on biliary tract	1（1.1%）	1（1.1%）	2	/	/
Pulmonary infection	Gastrointestinal surgery	2（2.2%）	7（7.7%）	9	/	/
Infection of incisional wound	Operation on biliary tract	0	1（1.1%）	1	/	/
Infection of incisional wound	Gastrointestinal surgery	1（1.1%）	1（1.1%）	2	/	/
Total		6	16		6.016	0.014

Item	EN group (n=45)	PN group (n=45)	t/χ² value	P value
Anus exhaust time	3.18±0.94	3.67±1.19	-2.168	0.033
hospitalization days	12.68±2.1	15.27±2.2	-5.713	<0.001