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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 221 -226. doi: 10.3877/cma.j.issn.2095-3232.2020.03.006

所属专题： 文献；

临床研究

两种营养风险筛查方法在加速康复模式下肝癌肝切除围手术期应用比较
宋鹏1, 毛谅2, 卞晓洁2, 周铁2, 凡银银2, 张静2, 孙士全2, 严笑鹏2, 伏旭2, 仇毓东3,†()   
  1. 1. 210008　南京医科大学鼓楼临床医学院
    2. 210008　南京大学医学院附属鼓楼医院肝胆胰外科
    3. 210008　南京医科大学鼓楼临床医学院；210008　南京大学医学院附属鼓楼医院肝胆胰外科
  • 收稿日期:2020-03-06 出版日期:2020-06-10
  • 通信作者: 仇毓东
  • 基金资助:
    江苏省医学重点人才培养项目(ZDRC2016057)

Comparison of two nutritional risk screening methods in perioperative period of hepatectomy for hepatocellular carcinoma under model of enhanced recovery after surgery

Peng Song1, Liang Mao2, Xiaojie Bian2, Tie Zhou2, Yinyin Fan2, Jing Zhang2, Shiquan Sun2, Xiaopeng Yan2, Xu Fu2, Yudong Qiu3,†()   

  1. 1. Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing 210008, China
    2. Department of Hepatobiliary and Pancreatic Surgery, Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, Nanjing 210008, China
    3. Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing 210008, China; Department of Hepatobiliary and Pancreatic Surgery, Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-03-06 Published:2020-06-10
  • Corresponding author: Yudong Qiu
  • About author:
    Corresponding author: Qiu Yudong, Email:
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引用本文：

宋鹏, 毛谅, 卞晓洁, 周铁, 凡银银, 张静, 孙士全, 严笑鹏, 伏旭, 仇毓东. 两种营养风险筛查方法在加速康复模式下肝癌肝切除围手术期应用比较[J]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 221-226.

Peng Song, Liang Mao, Xiaojie Bian, Tie Zhou, Yinyin Fan, Jing Zhang, Shiquan Sun, Xiaopeng Yan, Xu Fu, Yudong Qiu. Comparison of two nutritional risk screening methods in perioperative period of hepatectomy for hepatocellular carcinoma under model of enhanced recovery after surgery[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 221-226.

目的

探讨营养风险筛查2002（NRS2002）和患者自评-主观全面评定量表（PG-SGA）两种营养评估方法在肝癌肝切除加速康复模式中的应用效能。

方法

回顾性分析2014年1月至2018年7月在南京鼓楼医院行肝癌手术切除的90例患者临床资料。其中男75例，女15例；年龄35～74岁，中位年龄60岁。患者均签署知情同意书，符合医学伦理学规定。术前分别依据NRS2002、PG-SGA评分将患者分别分为营养不良风险组和正常营养组。两组营养指标比较采用t检验。术后并发症发生率比较采用χ2检验或Fisher确切概率法。

结果

NRS2002营养不良风险组患者术前平均握力（29±8）kg，明显低于正常营养组的（34±7）kg（t=-2.364，P<0.05）。NRS2002营养不良风险组术后总体并发症为73%（11/15），肺部感染发生率27% （4/15），明显高于正常营养组的43% （32/75）、4%（3/75） （χ2=4.712，8.954；P<0.05）。PG-SGA营养不良风险组术后肺部感染发生率为15%（3/20），明显高于正常营养组6%（4/70） （χ2=0.041，P<0.05）。

结论

在肝癌肝切除加速康复模式下，与PG-SGA评分相比，术前NRS2002评分能更准确反映术前患者营养状况，更有效预测术后并发症。

关键词: 营养状况, 肝切除术, 手术后并发症, 围手术期医护
Objective

To compare the efficiency of nutritional risk screening 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) in hepatectomy for hepatocellular carcinoma (HCC) under the model of enhanced recovery after surgery (ERAS).

Methods

Clinical data of 90 patients undergoing hepatectomy in Nanjing Drum Tower Hospital from January 2014 to July 2018 were retrospectively analyzed. Among them, 75 patients were male and 15 female, aged 35-74 years old with a median age of 60 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. Prior to surgery, all patients were divided into the malnutrition risk and normal nutrition groups according to the NRS2002 and PG-SGA scores. The nutritional indexes between two groups were statistically compared by t test. The incidence of postoperative complications was compared by Chi-square test or Fisher's exact probability test.

Results

The preoperative average grip strength in NRS2002 malnutrition risk group was (29±8) kg, significantly less than (34±7) kg in normal nutrition group (t=-2.364, P<0.05). The incidence of postoperative complications in NRS2002 malnutrition risk group was 73%(11/15) and the incidence of pulmonary infection was 27%(4/15), significantly higher compared with 43%(32/75) and 4%(3/75) in normal nutrition group (χ2=4.712, 8.954; P<0.05). The incidence of postoperative pulmonary infection in malnutrition risk group by PG-SGA was 15%(3/20), significantly higher than 6%(4/70) in the normal nutrition group (χ2=0.041, P<0.05).

Conclusions

Compared with PG-SGA score, preoperative NRS2002 score can more accurately reflect the preoperative nutritional status of patients and more effectively predict the risk of postoperative complications under the model of ERAS of hepatectomy.

Key words: Nutritional status, Hepatectomy, Postoperative complications, Perioperative care
表1 NRS2002评分营养不良和正常营养组患者围手术期指标比较（±s）
组别 例数 握力（kg） TSF （mm） MAMC （cm） BMI （kg/m2） ALB （g/L） 前白蛋白（g/L） LMR LNR PNI评分（分）
营养不良风险组 15 29±8 15±6 24.2±2.3 23.8±1.4 39.7±2.3 201±25 4.8±1.4 0.6±0.3 46.6±2.3
正常营养组 75 34±7 14±5 24.9±2.7 24.8±2.9 39.8±2.6 206±45 4.4±1.8 0.6±0.2 48.0±3.5
t值 ? -2.364 0.593 -1.018 -1.172 -0.215 -0.385 0.678 0.237 -1.468
P值 ? 0.033 0.335 0.284 0.183 0.713 0.458 0 0.858 0.147
表2 PG-SGA营养不良和正常营养组患者围手术期指标比较（±s）
组别 例数 握力（kg） TSF （mm） MAMC （cm） BMI （kg/m2） ALB （g/L） 前白蛋白（g/L） LMR LNR PNI评分（分）
营养不良风险组 20 31±7 15±6 24.1±2.3 24.1±2.0 40.5±1.9 191±38 4.4±1.6 0.54±0.24 48.0±2.7
正常营养组 70 34±8 13±5 25.0±2.7 24.7±2.8 39.6±2.6 210±43 4.5±1.8 0.57±0.20 47.7±3.6
t值 ? -1.719 1.512 -1.383 -0.788 1.425 -1.720 -0.094 -0.514 0.266
P值 ? 0.105 0.132 0.176 0.383 0.090 0.067 0.800 0.388 0.600
表3 NRS2002和PG-SGA营养风险分组术后并发症发生率比较[例（%）]
并发症 NRS2002 χ 2值 P值 PG-SGA χ 2值 P值
营养不良风险 正常营养 营养不良风险 正常营养
总体并发症 11（73） 32（43） 4.712 0.029 12（60） 31（44） 1.540 0.215
肝功能不全 0（0） 0（0） - - 0（0） 0（0） - -
胆漏 0（0） 1（1） - 0.833 0（0） 1（1） - 0.778
感染相关并发症 4（27） 9（12） 2.176 0.053 5（25） 8（11） 2.318 0.125
导管相关感染 0（0） 3（4） - 0.575 1（5） 2（3） 0.222 0.534
切口感染 0（0） 1（1） - 0.833 0（0） 1（1） - 0.778
肺部感染 4（27） 3（4） 8.954 0.014 3（15） 4（6） 5.355 0.041
腹部感染 1（7） 3（4） 0.209 0.524 1（5） 3（4） 0.019 0.641
尿路感染 0（0） 1（1） - 0.833 1（5） 0（0） - 0.222
腹腔积液 4（27） 12（16） 0.973 0.258 3（15） 13（19） 0.136 0.502
胸腔积液 6（40） 14（19） 3.291 0.075 6（30） 14（20） 0.900 0.254
严重并发症 2（13） 5（7） 0.775 0.330 1（5） 6（9） 0.277 0.511
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