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  • 李 伟,陈一秋,郭盼盼,等.全程营养管理模式在泌尿系统恶性肿瘤手术患者加速康复中的应用[J].同济大学学报(医学版),2020,41(4):487-491.    [点击复制]
  • LI Wei,CHEN Yi-qiu,GUO Pan-pan,et al.Application of nutritional management in enhanced recovery after surgery(ERAS) for patients with urological malignancy[J].同济大学学报(医学版),2020,41(4):487-491.   [点击复制]
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全程营养管理模式在泌尿系统恶性肿瘤手术患者加速康复中的应用
李伟,陈一秋,郭盼盼,曲志华,卓嘉璐,高明波,韩婷
0
(同济大学附属第十人民医院临床营养科,上海 200072)
摘要:
目的 探讨加速康复外科(enhanced recovery after surgery, ERAS)中的营养管理对泌尿系围手术期肿瘤患者康复情况的影响。方法 采用定点连续采样的方法,选取2017年12月—2018年4月同济大学附属第十人民医院泌尿外科收治的泌尿系恶性肿瘤手术患者作为研究对象,依据是否实施ERAS将患者分为实验组(ERAS营养管理)和对照组(传统围手术期管理)。比较两组患者营养风险筛查评分、患者主观整体营养评估评分,术前及术后的血清白蛋白、血红蛋白、前白蛋白、C反应蛋白、血糖浓度和白细胞、淋巴细胞计数、主观舒适度(饥饿感、口渴感、疼痛感、焦虑感)评分,术后恢复经口进食时间、并发症发生情况、营养支持情况、疾病转归情况、住院时间及住院费用。结果 按照纳入标准与排除标准,共收集患者102例,其中实验组57例,对照组45例。与对照组相比,实验组术后血清前白蛋白浓度升高、C反应蛋白浓度降低、手术前后的口渴感及术前焦虑感降低、术后恢复进食时间缩短、疾病转归较好(P<0.05)。结论 加速康复外科中的营养管理有助于减少泌尿系恶性肿瘤患者手术造成的应激反应、改善主观舒适度、改善术后营养状态及疾病转归情况,从而促进康复。
关键词:  加速康复外科  临床营养管理  泌尿系恶性肿瘤  围手术期  住院患者
DOI:10.16118/j.1008-0392.2020.04.015
投稿时间:2019-12-20
基金项目:同济大学附属第十人民医院临床路径课题(LCLJKT1819-11)
Application of nutritional management in enhanced recovery after surgery(ERAS) for patients with urological malignancy
LI Wei,CHEN Yi-qiu,GUO Pan-pan,QU Zhi-hua,ZHUO Jia-lu,GAO Ming-bo,HAN Ting
(Dept. of Clinical Nutrition, Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China)
Abstract:
Objective To evaluate the application of nutritional management in enhanced recovery after surgery(ERAS) for patients with urologic tumor. Methods One hundred and two patients with urological tumors undergoing surgical treatment in the Department of Urology of the Shanghai Tenth People's Hospital from December 2017 to April 2018 were enrolled. There were 57 patients receiving ERAS nutritional management(the intervention group) and 45 patients receiving conventional perioperative management(the control group). The NRS2002 score, PG-SGA score, biochemical indicators including serum albumin, hemoglobin, prealbumin, C reactive protein(CRP), blood glucose and white blood cell, lymphocyte count before and after treatment were compared between two groups. Meanwhile, the subjective well-being(sense of hunger, thirst, pain and anxiety),VAS score before and after operation, postoperative feeding time, complications, nutritional support, prognosis of disease, length of stay and cost were also compared between the two groups. Results Compared with the control group, the intervention group had higher level of prealbumin, lower level of CRP, thirst and pre-operative anxiety and earlier postoperative feeding time. Moreover, they had better disease outcomes(all P<0.05). Conclusion The ERAS nutritional management for patients with urologic tumor can reduce stress caused by operation, and improve subjective well-being, postoperative nutrition state and prognosis of disease, thereby promoting the rehabilitation.
Key words:  enhanced recovery after surgery  clinical nutritional management  urological neoplasms  perioperative period  hospital patient

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