ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
目的 运用营养风险筛查2002工具对普外科患者进行营养风险状况和营养支持现状调查。 方法 对2011年3月－8月在普外科新入院的520例患者进行营养风险筛查，判定是否存在营养风险，同时用已纳入患者现有的临床营养支持状况，分析目前临床营养支持的合理性。 结果 476例（91.5%）患者完成筛查。有营养风险者156例（32.8%），无营养风险者320例（67.2%）。在有营养风险患者中，实施临床营养支持者有131例，占84.0%；无营养风险患者中，实施了营养支持者占40.3%。 结论 基层县级医院普外科入院患者营养风险发生率较高，并且临床营养支持合理性尚待改善。
【摘要】 目的 探讨使用营养风险筛查（nutritional risk screening，NRS）2002与生理生化指标联合评估大肠癌患者术前营养及二者的定量关系。 方法 对2008年4月-2009年3月收治的367例大肠癌患者，用NRS 2002与生理生化指标分别评估其术前营养风险和营养状况，对其进行相关性分析。 结果 有28%的大肠癌患者术前即存在营养风险，各评价指标对营养不良状况的检出率存在差异（9.3%～31.6%），且NRS 2002营养风险评分与血红蛋白（r=-0.117，P=0.025）、血清前白蛋白（r=-0.205，P=0.046）、血清白蛋白（r=-0.175，P=00.001）、体量质指数（r=-0.231，P=0.000）均呈负相关。 结论 大肠癌患者术前即存在较高的营养风险和营养不良，且营养风险与术前营养状况有关。【Abstract】 Objective To assess the preoperative nutritional risks and status of patients with colorectal cancer by nutritional risk screening 2002 (NRS 2002) combined with physiological-biochemical indicators, and explore their quantitative relationship. Methods NRS 2002 combined with physiological-biochemical indicators were applied on the 367 patients with colorectal cancer in Gastrointestinal Surgery Center in West China Hospital between April 2008 and March 2009 to assess their nutritional risks and status, and correlation analysis was done to explore their quantitative relationship. Results Among all the patients, 28% had preoperative nutritional risks. Different physiological-biochemical indicators detected different rates of malnutrition (9.3% to 31.6%), and there was a negative correlation between NRS 2002 and such physiological-biochemical indicators as hemoglobin (r=-0.117,P=0.025), pre-albumin (r=-0.205,P=0.046), albumin (r=-0.175,P=0.001), and body mass index (r=-0.231,P=0.000). Conclusion Many colorectal cancer patients have preoperative nutritional risks and malnurtrion, and the nutritional risks are correlated with preoperative nutritional status.
【摘要】 目的 调查胃癌患者的营养风险及营养支持应用现状。 方法 2009年9月-2010年1月，对某三甲医院普外科收治的120例胃癌住院患者营养情况进行营养风险筛查2002（nutritional risk screening 2002，NRS 2002）评估，并就营养支持应用方式进行分析。 结果 所有患者中营养不足和营养风险的发生率分别为11.7%和27.5%；在33例有营养风险患者中，有26例（78.8％）接受了营养支持；在无营养风险的87例患者中，有30例（34.5％）接受了营养支持。 结论 对有营养风险的患者进行必要的营养支持，对于减少患者住院期间感染性并发症或其他不良临床结局的发生有积极作用。NRS 2002的方法简便，适用于胃癌患者的营养风险筛查，但医护人员需要进一步加强对肠外、肠内营养指南的认识。【Abstract】 Objective To investigate the clinical situation of nutritional risk screening for hospitalized patients with gastric cancer. Methods From September 2009 to January 2010, we applied nutrition risk screening 2002 (NRS 2002) to investigate the nutritional status of 120 hospitalized gastric cancer patients in the surgery department of a tertiary hospital, and analyzed the way of nutritional support for these patients. Results Among all the patients, the incidences of undernutrtion and nutritional risk were respectively 11.7% and 27.5%. Twenty-six out of the 33 nutritional risk patients received nutrition support, and 30 out of the 87 patients without nutritional risk received nutrition support. Conclusions Nutritional support for patients with nutritional risk is important in decreasing the occurrence of in-hospital infectious complications and other bad clinical outcomes. NRS 2002 is a simple and easy tool for predicting the nutrition risk in hospitalized gastric cancer patients, but the guideline of enteral nutrition and parenteral nutrition must be reinforced among doctors and nurses.
【摘要】 目的 评价以问题为基础式学习与病例讨论式学习在“临床风险筛查”培训教学过程中的应用效果。 方法 2010年6月-2011年7月，联合应用两种教学方法对参训医学生进行培训，然后进行临床资料采集、资料整理等实践活动。最后，对学生培训效果进行总结。 结果 共培训医学生50人，并对398例患者进行营养风险筛查。45人（90%）参与者认为此教学方式能激发自身主动学习兴趣，40人（80%）认为通过此次培训能够使学生逐步建立科学研究的思维方式，但有20人（40%）认为短期内采用两种教学方式能够对论文写作、统计学理论和实践等方面能力的提高有促进作用。影响医学生科研能力培训效果的主要因素集中体现在学习任务量的加重、对新教学方法不适应、自学能力三方面。 结论 联合应用问题为基础式学习与病例讨论式学习教学模式，在提高医学生学习主动性、积极性、团队合作及人际沟通能力等方面有优势，但尚存部分问题需要进一步解决。【Abstract】 Objective To explore the effectiveness of problem-based learning (PBL) and case-based study (CBS) in clinical nutritional risk screening training program. Methods All the students were trained by the combination methods of PBL and CBS. Clinical assessment, data collection and the collection of samples were conducted by the students. Finally, the impact of the new teaching strategy was assessed. Results From June 2010 to July 2011, there were a total of 50 students who attended the training program from various departments, and 398 patients were screened for nutritional risk. Forty-five students (90%) thought that this teaching method could inspire their interest in study; 40 students (80%) thought that this teaching method could help them establish a scientific way of thinking. Students who thought this teaching methodology could contribute to their enhancement of writing and statistical skills accounted for only 40 percent of the total enrollment. “High learning burden”, “difficulty in adapting to the new teaching methods” and “the ability of self-study” were the main factors which affected the motivation of students. Conclusions Combined applications of PBL and CBS have advantages in improving students′ learning initiative and enthusiasm, and developing the abilities of team cooperation and interpersonal communication skills. However, there are still some issues that need to be addressed.