ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
【摘要】 目的 调查胃癌患者的营养风险及营养支持应用现状。 方法 2009年9月-2010年1月，对某三甲医院普外科收治的120例胃癌住院患者营养情况进行营养风险筛查2002（nutritional risk screening 2002，NRS 2002）评估，并就营养支持应用方式进行分析。 结果 所有患者中营养不足和营养风险的发生率分别为11.7%和27.5%；在33例有营养风险患者中，有26例（78.8％）接受了营养支持；在无营养风险的87例患者中，有30例（34.5％）接受了营养支持。 结论 对有营养风险的患者进行必要的营养支持，对于减少患者住院期间感染性并发症或其他不良临床结局的发生有积极作用。NRS 2002的方法简便，适用于胃癌患者的营养风险筛查，但医护人员需要进一步加强对肠外、肠内营养指南的认识。【Abstract】 Objective To investigate the clinical situation of nutritional risk screening for hospitalized patients with gastric cancer. Methods From September 2009 to January 2010, we applied nutrition risk screening 2002 (NRS 2002) to investigate the nutritional status of 120 hospitalized gastric cancer patients in the surgery department of a tertiary hospital, and analyzed the way of nutritional support for these patients. Results Among all the patients, the incidences of undernutrtion and nutritional risk were respectively 11.7% and 27.5%. Twenty-six out of the 33 nutritional risk patients received nutrition support, and 30 out of the 87 patients without nutritional risk received nutrition support. Conclusions Nutritional support for patients with nutritional risk is important in decreasing the occurrence of in-hospital infectious complications and other bad clinical outcomes. NRS 2002 is a simple and easy tool for predicting the nutrition risk in hospitalized gastric cancer patients, but the guideline of enteral nutrition and parenteral nutrition must be reinforced among doctors and nurses.
ObjectiveTo explore the nutritional status of inpatients with chronic kidney disease (CKD) and analyze the factors affecting nutritional risk, to provide theoretical basis for further nutritional support.MethodsConvenience sampling method was adopted to select 719 inpatients with CKD as research subjects in a tertiary hospital in Chengdu, Sichuan Province from January to March 2018. Nutritional Risk Screening 2002 was used for nutritional risk screening, and chi-square test, t test, one-way analysis of variance, and multiple linear regression analysis were used to explore the influencing factors of nutritional risk.ResultsAmong the 719 cases, whose average nutritional risk score was 1.79±1.11, 158 cases had nutritional risk, accounting for 22.0%. There were statistically significant differences in nutritional risk score between patients of age<60 years and ≥60 years, between males and females, between patients with CKD stage 1-3 and stage 4-5, between patients with serum albumin level <30 g/L and ≥30 g/L, and between patients with and without anaemia (P<0.05). The results of multiple linear regression analysis showed that the nutritional risk score of CKD patients was negatively correlated to serum albumin level (P=0.016), positively correlated to age (P<0.001), and higher in females than that in males (P=0.001).ConclusionsInpatients with CKD have a higher nutritional risk, with age, gender and serum albumin as the main influencing factors. Based on the above factors, the medical staff should continue to take targeted intervention measures to assess the nutritional status of CKD inpatients early and conveniently, so as to provide scientific basis for further nutritional support and nutritional nursing.
目的 运用营养风险筛查2002工具对普外科患者进行营养风险状况和营养支持现状调查。 方法 对2011年3月－8月在普外科新入院的520例患者进行营养风险筛查，判定是否存在营养风险，同时用已纳入患者现有的临床营养支持状况，分析目前临床营养支持的合理性。 结果 476例（91.5%）患者完成筛查。有营养风险者156例（32.8%），无营养风险者320例（67.2%）。在有营养风险患者中，实施临床营养支持者有131例，占84.0%；无营养风险患者中，实施了营养支持者占40.3%。 结论 基层县级医院普外科入院患者营养风险发生率较高，并且临床营养支持合理性尚待改善。
ObjectiveTo investigate the prevalence of the nutritional risks, the relationship between application of nutritional support and the clinical outcome of patients with gastrointestinal major surgery in the Frist People's Hospital of Shuangliu. MethodsGastrointestinal major surgery patients in Department of General Surgery in the Frist People's Hospital of Shuangliu from March 2010 to March 2014 were consecutively enrolled. Patients who provided informed consent were screened by NRS 2002, tracking nutrition support status and analysis the relationship between nutrition support and clinical outcome. In this study, the clinical outcome index included postoperative complications and hospitalization time. ResultsThere were totally 130 cases enrolled, 112 cases completed assessment by NRS 2002. The prevalence of nutritional risk was 75.9%(85/112), there were totally 57 patients(50.9%) received nutrition support, and all for parenteral nutrition. The prevalence of postoperative complication was 46.4%(52/112). The prevalence of postoperative complication in patients who had nutritional risk and received nutritional support was 41.7%(15/36), whereas, in patients who had nutritional risk but not received nutritional support was 73.5%(36/49), there was statistically significant difference between the 2 groups(P=0.002). In patients who not had nutritional risk, the postoperative complication rate was only 3.7%(1/27). ConclusionsBecause of noninvasive and easy to operate, NRS 2002 are adpted to hospitalized patients with gastrointestinal major surgery. Because of the specific of disease metabolism, the higher nutritional risk occurres in patients with gastrointestinal major surgery, appropriate nutritional support for this kinds of patients can reduce the incidence of postoperative complication, and improve the prognosis.
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.