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.

相关文章 15

[1]	董恣豪,刘喆,王浩,于辰曦,杨光,丰浩田. 髋关节镜下关节囊不同切开方式早期术后并发症[J]. 山东大学学报 (医学版), 2026, 64(5): 83-87.
[2]	史潇兮,辛世杰. 腹主动脉瘤的开放手术[J]. 山东大学学报 (医学版), 2024, 62(9): 26-29.
[3]	王瑞霞,苏童,赵淑磊. 内镜逆行性胆胰管造影术罕见并发症-胆道支架无法拔除1例[J]. 山东大学学报 (医学版), 2024, 62(2): 113-115.
[4]	李红梅,蔡敏,周立,姚欣雨,刘力. 不同膈肌超声功能指标在腹部手术后肺部并发症中的预测价值[J]. 山东大学学报 (医学版), 2024, 62(10): 115-124.
[5]	徐荣坤,王连雷,原所茂,田永昊,刘新宇. 腰椎术中腹主动脉损伤1例并文献复习[J]. 山东大学学报 (医学版), 2023, 61(6): 121-124.
[6]	穆彦熹,李金洲,陈康,梁红英,姚亚龙,汪文杰,陈晓. 443例胃癌根治术后发生肺部并发症的危险因素[J]. 山东大学学报 (医学版), 2023, 61(4): 37-41.
[7]	林均馨,刘玉江,刘培来,万连平,张鹏,杜建春,刘泽淼,孔杰,高升焘. 固定平台单髁术后胫骨假体周围骨折2例[J]. 山东大学学报 (医学版), 2022, 60(3): 96-99.
[8]	韩丁培,严越,曹羽钦,孙昕,胡琰霞,汪敏娴,罗艳,施咏梅,谢青,杭钧彪,李鹤成. 加速康复外科理念在胸外科临床实践指导的瑞金医院专家共识[J]. 山东大学学报 (医学版), 2022, 60(11): 11-16.
[9]	田辉,易文波,李树海. 达芬奇机器人食管癌切除术之齐鲁实践[J]. 山东大学学报 (医学版), 2022, 60(11): 28-32.
[10]	孙振国,田辉. 加速康复外科指导下微创食管癌切除术流程优化之齐鲁实践[J]. 山东大学学报 (医学版), 2022, 60(11): 33-37.
[11]	张建平,罗莺儿. 抗凝药物在反复不良妊娠治疗中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 14-19.
[12]	邹俊逸,张辉,张歆杰,李子佳,许明雷,王东. 110例原位心脏移植临床经验[J]. 山东大学学报 (医学版), 2021, 59(8): 86-91.
[13]	章露文,范锐心,常颖,张晴. 微生态制剂肠内营养对43例重型颅脑损伤患者的疗效[J]. 山东大学学报 (医学版), 2021, 59(6): 111-116.
[14]	张小红,周云,杜秋莹,任慧欣,王超群. Atg7-siRNA通过调节精氨酸循环干扰食管癌ECA109细胞放疗敏感性[J]. 山东大学学报 (医学版), 2021, 59(4): 28-34.
[15]	罗应舒,李宾,许昌芹,姜军梅,许洪伟. 240例上消化道黏膜下肿瘤内镜治疗的疗效及并发症评估[J]. 山东大学学报 (医学版), 2021, 59(3): 74-80.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed