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史哲溪,康凯,舒晓亮.个体化营养治疗对消化系统手术围手术期患者营养状况的影响[J].Academic Journal of Second Military Medical University ,2020,41(1):24-31
个体化营养治疗对消化系统手术围手术期患者营养状况的影响    点此下载全文 Fulltext
史哲溪1  康凯1  舒晓亮2*
1. 同济大学医学院营养与食品卫生教研室, 上海 200092;
2. 同济大学附属东方医院营养科, 上海 200120
*通信作者
基金项目:"十二五"国家科技支撑计划(2012BAI35B).
DOI:10.16781/j.0258-879x.2020.01.0024
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摘要:
      目的 探讨个体化营养治疗对存在营养风险的消化系统手术围手术期患者营养状况的影响。方法 本研究为前瞻性、随机对照临床试验。对择期行消化系统手术的患者进行营养风险筛查,将存在营养风险、筛选合格且签署知情同意书的231例患者随机分为研究组(n=115)和对照组(n=116),分别给予个体化营养治疗和非个体化营养治疗15 d(术前5 d至术后9 d)。采集基线数据,分别于入组时及营养治疗第5天、第9天、第15天采集患者空腹静脉血,测量患者BMI、血清总蛋白、血清白蛋白、血清前白蛋白、血糖、总胆固醇、三酰甘油、淋巴细胞计数及白细胞计数等指标。结果 最终纳入患者217例(研究组112例、对照组105例),中途退出14例(6.1%)。(1)组内比较:研究组患者在入组时及营养治疗第5天、第9天、第15天时血清总蛋白、血清白蛋白、血清前白蛋白均呈先上升后下降再上升趋势(P均<0.05),淋巴细胞计数、白细胞计数均呈先下降后上升趋势(P均<0.05),但均在正常范围内;对照组患者在入组时及营养治疗第5天、第9天、第15天时血清白蛋白呈先下降后上升趋势(P<0.05),血清前白蛋白、淋巴细胞计数呈先上升后下降再上升趋势(P均<0.05),但均在正常范围内;其余指标组内比较差异均无统计学意义(P均>0.05)。(2)组间比较:研究组患者血清总蛋白和血清白蛋白水平均高于对照组(P均<0.05);术前1 d(营养治疗第5天)研究组白细胞计数低于对照组,但术后第9天(营养治疗第15天)研究组白细胞计数高于对照组(P<0.05);其余指标组间比较差异均无统计学意义(P均>0.05)。(3)分组与时间交互效应:组间比较的结果表明时间因素不影响营养和免疫相关指标(P>0.05)。结论 个体化营养治疗有利于改善存在营养风险的消化系统手术围手术期患者的营养状况。
关键词:个体化营养治疗  消化系统  围手术期  营养状况
Effects of individualized nutritional therapy on nutritional status of patients in perioperative period of digestive system operation    Fulltext
SHI Zhe-xi1  KANG Kai1  SHU Xiao-liang2*
1. Department of Nutrition and Food Hygiene, Tongji University School of Medicine, Shanghai 200092, China;
2. Department of Nutrition, East Hospital, Tongji University, Shanghai 200120, China
*Corresponding author
Fund Project:Supported by National Science & Technology Pillar Program of "12th Five-Year Plan" (2012BAI35B).
Abstract:
      Objective To explore the effect of individualized nutritional therapy on nutritional status of patients with nutritional risk in the perioperative period of the digestive system operation. Methods This study was a prospective, randomized, controlled clinical trial. Patients undergoing elective digestive surgery were screened for nutritional risk. And 231 patients who had nutritional risk and signed informed consent were randomized into study group (n=115) and control group (n=116). Individualized and non-individualized nutritional treatments were given for 15 d (5 d before surgery and 9 d after surgery) in two groups. The baseline data were collected. At admission, and on day 5, 9 and 15 after nutrition treatment, venous blood samples were collected, and relevant indicators, such as the body mass index (BMI), serum total protein, albumin, prealbumin, blood glucose, total cholesterol, triglyceride, lymphocyte count and white blood cell count, were measured. Results At the end of the trial, 217 patients were collected from the study group (n=112) and control group (n=105). Fourteen patients (6.1%) withdrew from the study. In the study group, the levels of serum total protein, albumin and prealbumin were first increased, then decreased, and then increased again (P<0.05); the lymphocyte count and white blood cell count were first decreased and then increased (P<0.05); all were within the normal range. In the control group, serum albumin level was first decreased and then increased (P<0.05); serum prealbumin level and lymphocyte count were increased, then decreased, and then increased again (P<0.05); all were within the normal range; there were no significant differences in the other indicators (P>0.05). Serum total protein and albumin levels were significantly higher in the study group than those in the control group (P<0.05). White blood cell count was lower in the study group than that in the control group on day one before surgery (P<0.05), but white blood cell count was higher in the study group than that in the control group on day 9 after surgery (P<0.05). There was no significant difference in the other indexes between the two groups (P>0.05). The duration of nutrition treatment was not related to nutritional or immune indexes (P>0.05). Conclusion Individualized nutritional therapy can improve the nutritional status of patients with nutritional risks in the perioperative period of the digestive system operation.
Keywords:individualized nutritional therapy  digestive system  perioperative period  nutritional status
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