33例食管癌患者围术期补充乳清蛋白粉对术后并发症的预防作用

doi:10.6040/j.issn.1671-7554.0.2021.0875

摘要/Abstract

摘要： 目的探讨围术期补充乳清蛋白对食管癌术后并发症发生率及营养状态的影响。方法选取2017年4月至2018年6月某医院择期食管癌切除术的患者为研究对象,按1∶1将患者随机分为观察组和对照组,通过营养风险筛查表(NRS2002)、患者主观整体评估量表(PG-SGA)、人体成分测定等对两组患者于术前门诊、术前1天、术后1个月进行营养和身体方面的评估。两组患者均进行常规营养干预。此外,观察组在术前门诊还开始补充乳清蛋白粉,干预周期至术后1个月。比较两组术后1个月的并发症发生率［并发症界定为2级以上的感染相关的并发症(包括肺部感染、呼吸道感染、吻合口瘘等)］;比较基线、术前1天、术后1个月营养状态的差异。结果两组患者术后并发症的发生率,观察组为24%(8/33),对照组为49%(18/37),两组差异有统计学意义(P<0.05)。其他观察指标2组间差异没有统计学意义。结论围术期补充乳清蛋白联合肠内营养可以有效降低食管癌术后1个月的感染性并发症的发生率,但样本量小,还有待进一步验证。

关键词: 食管癌, 乳清蛋白, 肠内营养, 并发症

Abstract: Objective To investigate the effects of whey protein on the postoperative complications and nutritional status of patients with esophageal cancer. Methods Patients with esophageal squamous cell cancer who underwent elective surgery during April 2017 and June 2018 were enrolled and randomly divided into observation group and control group at a ratio of 1:1. Nutritional risk screening 2002(NRS2002), Patient-Generated Subjective Global Assessments(PG-SGA)and composition measurement were used to screen and evaluate the nutritional status before operation, one day before operation and one month after operation. All patients were given basic nutritional support. In addition, whey protein powder was given to the observation group, and the intervention was continued until 1 month after surgery. The incidence of complications(above grade 2 complications including lung infection, respiratory tract infection, anastomotic leakage)was compared one month after surgery; the differences in nutritional status were compared at baseline, one day before surgery and one month after surgery. Results The incidence of complications was 24% in the observation group and 49% in the control group(P<0.05). There were no differences in the other indicators. Conclusion Preoperative whey protein supplementation combined with enteral nutrition can effectively reduce the incidence of infectious complications in patients with esophageal cancer one month after surgery. However, our sample size is small and the research results need to be further verified.

Key words: Esophageal cancer, Whey protein, Enteral nutrition, Complications

中图分类号:

R735.1

王艳莉,冯晔,周秀耕,杨跃,吴楠,方玉,阎石,李少雷,吕超,韩超,杜松涛. 33例食管癌患者围术期补充乳清蛋白粉对术后并发症的预防作用[J]. 山东大学学报 (医学版), 2022, 60(3): 64-70.

WANG Yanlig, FENG Ye, ZHOU Xiugeng, YANG Yue, WU Nan, FANG Yu, YAN Shi, LI Shaolei, LYU Chao, HAN Chao, DU Songtao. Preliminary observation of perioperative whey protein supplementation for the prevention of postoperative complications in 33 patients with esophageal cancer[J]. Journal of Shandong University (Health Sciences), 2022, 60(3): 64-70.

参考文献

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2] Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014 [J]. Chin J Cancer Res, 2018, 30(1): 1-12.
[3] Gannon JA, Guinan EM, Doyle SL, et al. Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study [J]. Dis Esophagus, 2017, 30(8): 1-7.
[4] Elliott JA, Doyle SL, Murphy CF, et al. Sarcopenia: prevalence, and impact on operative and oncologic outcomes in the multimodal management of locally advanced esophageal cancer [J]. Ann Surg, 2017, 266(5): 822-830.
[5] 韩东景, 赵楠, 李伟, 等.食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查[J].中华肿瘤防治杂志, 2013, 20(16): 1274-1278. HAN Dongjing, ZHAO Nan, LI Wei, et al. Occurrence rate of preoperative nutritional risk, malnutrition and the current status of clinical nutritional support of patients with esophageal cancer [J]. Chinese Journal of Cancer Prevention and Treatment, 2013, 20(16): 1274-1278.
[6] Ryan AM, Rowley SP, Healy LA, et a1. Post-oesophageetomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit [J]. Clin Nutr, 2006, 25(3): 386-393.
[7] Schiesser M, Kirchhoff P, Mfiller MK, et a1. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery [J]. Surgery, 2009, 145(5): 519-526.
[8] Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population [J]. Curr Opin Clin Nutr Metab Care, 2005, 8(1): 23-32.
[9] Minnella EM, Awasthi R, Loiselle S, et al.Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery:a randomized clinical trial [J]. JAMA Surg, 2018, 153(12): 1081-1089.
[10] Gibson RS. Principles of nutritional assessment [M]. New York: Oxford University Press, 2005.
[11] Kondrup J, Rasmussen HH, Hoc ESPEN Working Group. Nutritional risk screening(NRS 2002): a new method based on an analysis of controlled trials [J]. Clin Nutr, 2003, 22(3): 321-326.
[12] Bauer J, Capra S, Ferguson M. Use of the scored patient-generated subjective global assessment(PG-SGA)as a nutrition assessment tool in patients with cancer [J]. Eur J Clin Nutr, 2002, 56(8): 779-785.
[13] Wei Chen, MD, PhD, Hua Jiang, et al. Body composition analysis by using bioelectrical impedance in a young healthy Chinese population: methodological considerations [J]. Food Nutr Bull, 2017, 38(2): 172-181.
[14] Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].Ann Sury, 2004, 240(2): 205-213.
[15] Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care [J]. Anesthesiol Clin, 2015, 33(1): 17-33.
[16] Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with Esophagectomy [J]. Ann Surg, 2018, 269(2): 291-298.
[17] 关毅.术前口服乳清蛋白对胃肠道肿瘤手术患者胰岛素抵抗和应激反应的影响研究[J].中国全科医学,2012,15(111):3875-3877. GUAN Yi. Effects of orally taking whey protein before operation on insulin resistance and acute phase response in patients with gastrointestinal tumors [J]. Chinese General Practice, 2012, 15(111): 3875-3877.
[18] Micke P, Beeh KM, Schlaak JF, et al. Oral supplementation with whey proteins increases plasma glutathione levels of HIV-infected patients [J]. Eur J Clin Invest, 2015, 31(2): 171-178.
[19] Gupta C. Whey proteins: a novel source of bioceuticals [J]. Middle-East J Sci Res, 2012, 12(3): 365-375.
[20] Gillis C, Loiselle SE, Fiore JF, et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial [J]. Acad Nutr Diet, 2016, 116(5): 802-812.
[21] Madzima TA, Ormsbee MJ, Schleicher EA, et al. Effects of resistance training and protein supplementation in breast cancer survivors [J]. Med Sci Sports Exerc, 2017, 49(7): 1283-1292.

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