快速康复外科和营养风险筛查在乳腺癌围手术期的应用
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摘要
目的探讨快速康复外科及营养风险筛查在乳腺癌围手术期的应用。方法选取2017年11月—2018年3月广西医科大学第一附属医院胃肠腺体外科收治的70例乳腺癌患者作为研究组,患者术前均行营养风险筛查,并按该科乳腺癌快速康复外科流程进行围手术期处理;选取2015年8月—2015年10月该院按乳腺癌规范流程进行围手术期处理的患者75例作为对照组。根据NRS-2002得分将患者分为营养正常组和营养风险组,分别有59和11例。对患者的临床数据进行比较分析。结果两组患者术后6和24 h疼痛程度比较,差异有统计学意义(P<0.05);两组术后恶心呕吐发生率比较,差异有统计学意义(P<0.05);研究组术后住院时间短于对照组(P <0.05);营养正常组与营养风险组患者术后第1、2及3天的引流量比较,采用重复测量设计的方差分析,结果:①两组患者术后不同时间的引流量比较,差异有统计学意义(P <0.05);②营养正常组引流量比营养风险组少(P<0.05);③两组患者引流量的变化趋势比较,差异无统计学意义(P>0.05)。结论乳腺癌快速康复外科流程在乳腺癌围手术期能降低患者术后疼痛和恶心呕吐发生率,缩短住院时间;营养状况是乳腺癌快速康复外科的基石之一,术前风险筛查有助于乳腺癌快速康复外科实施对象的合理选择。
Objective To explore the application of enhanced recovery after surgery(ERAS) and nutritional risk screening(NRS) in perioperative period of breast cancer. Methods From November 2017 to March 2018, 70 patients with breast cancer in the Gastrointestine and Gland Surgery of First Affiliated Hospital of Guangxi medical University were selected as research objects, and all patients were screened for nutritional risk before the surgery and received ERAS in our department for perioperative treatment. We retrospectively collected 75 patients who underwent normative perioperative management of breast cancer in our department from August 2015 to October2015 as a control group. According to NRS-2002 score, patients were divided into normal nutrition group and nutritional risk group, with 59 and 11 cases respectively. Clinical data were comparative analyzed. Results The pain scores at 6 hours and the pain scores at 24 hours after surgery were statistically significant(P < 0.05); the incidence of postoperative nausea and vomiting in the study group and the control group were 1.43% and 10.67% respectively,and the difference was statistically significant(χ~2= 5.308, P = 0.034); the postoperative hospital stay was lower in the normal nutrition group than that in the nutritional risk group(t = 3.222, P = 0.002); ① the drainage volume after surgery of the first, second and third days was different(F = 10.006, P = 0.000); ② the drainage volume of the normal nutrition group was less than that of the nutritional risk group, and the difference was statistically significant(F = 4.698, P = 0.034); ③ the change trend of the drainage volume was the same in the normal nutrition group and the nutritional risk group(F = 0.514, P = 0.476). Conclusions ERAS reduces postoperative pain, nausea and vomiting,and shortens hospital stay in perioperative management of breast cancer; nutritional status is one of the cornerstones of ERAS of breast cancer; preoperative NRS is helpful for the rational selection of breast cancer rapid rehabilitation.
Objective To explore the application of enhanced recovery after surgery(ERAS) and nutritional risk screening(NRS) in perioperative period of breast cancer. Methods From November 2017 to March 2018, 70 patients with breast cancer in the Gastrointestine and Gland Surgery of First Affiliated Hospital of Guangxi medical University were selected as research objects, and all patients were screened for nutritional risk before the surgery and received ERAS in our department for perioperative treatment. We retrospectively collected 75 patients who underwent normative perioperative management of breast cancer in our department from August 2015 to October2015 as a control group. According to NRS-2002 score, patients were divided into normal nutrition group and nutritional risk group, with 59 and 11 cases respectively. Clinical data were comparative analyzed. Results The pain scores at 6 hours and the pain scores at 24 hours after surgery were statistically significant(P < 0.05); the incidence of postoperative nausea and vomiting in the study group and the control group were 1.43% and 10.67% respectively,and the difference was statistically significant(χ~2= 5.308, P = 0.034); the postoperative hospital stay was lower in the normal nutrition group than that in the nutritional risk group(t = 3.222, P = 0.002); ① the drainage volume after surgery of the first, second and third days was different(F = 10.006, P = 0.000); ② the drainage volume of the normal nutrition group was less than that of the nutritional risk group, and the difference was statistically significant(F = 4.698, P = 0.034); ③ the change trend of the drainage volume was the same in the normal nutrition group and the nutritional risk group(F = 0.514, P = 0.476). Conclusions ERAS reduces postoperative pain, nausea and vomiting,and shortens hospital stay in perioperative management of breast cancer; nutritional status is one of the cornerstones of ERAS of breast cancer; preoperative NRS is helpful for the rational selection of breast cancer rapid rehabilitation.
引文
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[14]何苗,吴晓英,冯艺,等.术后疼痛管理新进展[J].中国护理管理,2014,14(11):1135-1137.
[15]王洁琼,武雪亮,郭飞,等.NRS 2002营养风险筛查在结直肠癌围手术期中的应用[J].中国医药导报,2018,15(2):100-103.
[16]SMITH Z L,GONZAGA J E,HAASLER G B,et al.Grade of esophageal cancer and nutrirional status impact on postsur-gery outcomes[J].Dig Dis Sci,2017,62(6):1647-1656.
[17]BESER O F,COKUGRAS F C,ERKAN T,et al.Evaluation of malnutrition development risk in hospitalized children[J].Nutrition,2018,48:40-47.
[18]徐忠凯,孙少川,薛意恒.胃肠外科患者营养风险筛查及围手术期营养支持对胃癌患者恢复影响的临床研究[J].中国普外基础与临床杂志,2017,24(7):837-842
[19]CHEN Y,LIU B L,SHANG B,et al.Nutrition support in surgical patients with colorectal cancer[J].World Journal of Gastroenterol,2011,17(13):1779-1786.
[2]石汉平,李薇,齐玉梅,等.营养筛查与评估[M].北京:人民卫生出版社,2014:1-26.
[3]ARRIBAS L,HURTóS,L SENDRóS M J,et al.NUTRISCORE:a new nutritional screening tool for oncological outpatients[J].Nutrition,2017,33:297-303.
[4]ABDIKARIM I,CAO X Y,LI S Z,et al.Enhanced recovery after surgery with laparoscopic radical gastretomy for stomach carcinomas[J].World Journal of Gastroenterology,2015,21(47):13339-13344.
[5]KEHLET H.Multimodal approach to control postoperative pathophy-siology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[6]WILMORE D W,KEHLET H.Management of patients in fast track surgery[J].BMJ,2001,322(7284):473-476.
[7]杜正文,高迎飞,王玉明,等.乳腺癌围手术期应用快速康复外科的临床研究[J].临床外科杂志,2016,24(4):263-265.
[8]黄兴华,胡还章,江艺,等.快速康复外科在肝癌患者围手术期的应用[J].国际外科学杂志,2016,43(4):228-230.
[9]PIMENTA G P,de AGUILAR-NASCIMENTO J E.Prolonged preoerative fasting in elective surgical patients:why should we reduce it[J].Nutr Clin Pract,2014,29(1):22-28.
[10]粟家平,杨小龙,丁柏应,等.快速康复外科在肺癌根治术用的价值[J].中国现代医学杂志,2016,26(22):108-111.
[11]RITTENBERGER J C,CALLAWAY C W.Temperature management and modern post-cardiac arrest care[J].N Engl JMed,2013,369(23):2262-2263.
[12]HELMINEN H,VIITANEN H,SAJANTI J.Effect of preoperative intravenous carbohydrate loading on Preoperativediseomfort in elective surgery patients[J].Eur J Anaesthsiol,2009,26(2):123-127.
[13]SARKIO S,HALME L,KYLL?NEN L,et al.Severe gastrointestinal complications after 1515 adult kidney transplantations[J].Transpl Int,2004,17(9):505-510.
[14]何苗,吴晓英,冯艺,等.术后疼痛管理新进展[J].中国护理管理,2014,14(11):1135-1137.
[15]王洁琼,武雪亮,郭飞,等.NRS 2002营养风险筛查在结直肠癌围手术期中的应用[J].中国医药导报,2018,15(2):100-103.
[16]SMITH Z L,GONZAGA J E,HAASLER G B,et al.Grade of esophageal cancer and nutrirional status impact on postsur-gery outcomes[J].Dig Dis Sci,2017,62(6):1647-1656.
[17]BESER O F,COKUGRAS F C,ERKAN T,et al.Evaluation of malnutrition development risk in hospitalized children[J].Nutrition,2018,48:40-47.
[18]徐忠凯,孙少川,薛意恒.胃肠外科患者营养风险筛查及围手术期营养支持对胃癌患者恢复影响的临床研究[J].中国普外基础与临床杂志,2017,24(7):837-842
[19]CHEN Y,LIU B L,SHANG B,et al.Nutrition support in surgical patients with colorectal cancer[J].World Journal of Gastroenterol,2011,17(13):1779-1786.