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目的胃癌是最常见的消化道恶性肿瘤,围手术期营养风险和并发症发生率较高,本研究旨在分析胃癌患者围手术期营养风险和并发症的影响因素。方法收集2011-11-01-2014-11-01山东大学附属山东省肿瘤医院胃肠外科876例胃癌手术患者的营养风险、营养支持和围手术期并发症等数据,分析营养风险以及并发症的相关因素,进一步分析营养支持和并发症的关系。结果(1)有营养风险492例,发生率为56.2%,其中积分3分占27.1%,4~7分占29.1%。单因素分析结果显示,年龄、临床分期、病理鲍曼分型和并发症与营养风险相关;多因素分析显示,年龄>65岁、病理Ⅲ期和并发症是独立危险因素。(2)有并发症158例,发生率为18.0%。单因素分析显示,年龄、病理分期、鲍曼分型、术中出血量、ASA评分、营养风险和并发症与并发症显著相关;多因素分析显示,年龄>65岁、病理分期Ⅲ期、营养风险、ASA评分和并发症是独立危险因素。(3)分层分析显示,有风险者营养支持并发症为17.9%,低于无规范营养支持的29.2%,无营养风险者营养支持对并发症无显著性影响。结论影响胃癌营养风险和并发症的独立危险因素有年龄、病理分期和并发症,营养风险为并发症的独立危险因素,规范的营养支持为营养风险者并发症的保护性因素。
Purpose Gastric cancer is the most common malignant tumor of the digestive tract. The perioperative nutritional risk and complication rate are high. This study aims to analyze the influencing factors of perioperative nutritional risk and complications in patients with gastric cancer. Methods 2011-11-01-2014-11-01 Department of Gastrointestinal Surgery, Shandong Tumor Hospital Affiliated to Shandong University 876 cases of gastric cancer surgery patients nutritional risk, nutritional support and perioperative complications and other data analysis of nutritional risks and complications Related factors, further analysis of the relationship between nutritional support and complications. Results (1) 492 cases of nutritional risk, the incidence was 56.2%, of which 3 points accounted for 27.1%, 4 to 7 points accounted for 29.1%. Univariate analysis showed that age, clinical stage, pathological Bowman’s classification and complications were related to nutrition risk. Multivariate analysis showed that age> 65 years old, pathological stage Ⅲ and complications were independent risk factors. (2) there are 158 cases of complications, the incidence was 18.0%. Univariate analysis showed that age, pathological stage, Bowman’s type, intraoperative blood loss, ASA score, nutrition risk and complications were significantly correlated with complications. Multivariate analysis showed that age> 65 years, pathological stage Ⅲ, nutrition Risk, ASA score and complications were independent risk factors. (3) Hierarchical analysis showed that the risk-supported nutritional support for complications was 17.9%, lower than 29.2% of those without normative nutrition support, and nutritional support without nutritional risk had no significant effect on the complication. Conclusion Independent risk factors affecting nutritional risk and complications of gastric cancer are age, pathological staging and complications. Nutritional risk is an independent risk factor for complication. Standardized nutrition support is a protective factor for complication of nutritional risk.