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目的观察老年胃肠道肿瘤患者围手术期静息能量代谢的变化规律。方法选择65-80岁胃肠道肿瘤患者73例,采用自身对照研究方法,于手术前、术后3-5d、术后7-10d三个时间点采用MedGeM床旁代谢仪测量静息能量代谢(restingenergy expenditure,REE),测量身高、体重、计算体重指数(BMI),微型营养评定(mini nutritional assesment,MNA)法评估营养状况,检测血生化指标及血前白蛋白、C反应蛋白。结果所有胃肠肿瘤患者术后3-5d的REE与术前比较无统计学差异(男术后3-5d(4 869.07±432.31)kJ/d vs术前(4 629.10±421.68)kJ/d,女术后3-5d(4 062.12±502.49)kJ/d vs术前(3 892.63±488.29)kJ/d,(P>0.05);与术前和术后3-5d比较,术后7-10d男性REE胃肠肿瘤患者均显著降低(男胃肿瘤术后7-10d(3 443.15±385.02)kJ/d vs术前(4 340.22±418.82)kJ/d和术后3-5d(4 600.47±434.45)kJ/d,男肠肿瘤术后7-10d(4 137.11±347.21)kJ/d vs术前(5 012.36±455.15)kJ/d和术后3-5d(5 091.66±421.89)kJ/d,(P<0.05);女性仅肠肿瘤患者显著降低(术后7-10d(3 766.56±388.08)kJ/d vs术前(4 180.08±305.86)kJ/d和术后3-5d(4 477.11±416.47)kJ/d,P<0.05)。男性患者术后3-5d和7-10d的血红蛋白值、淋巴细胞总数与术前比较均显著下降(术后3-5d和7-10d血红蛋白(131.07±24.18)g/L和(125.08±23.82)g/L vs术前(147.79±14.82)g/L,术后3-5d和7-10d淋巴细胞总数(1 363.95±570.76)/ml和(1 316.78±589.66)/mlvs术前(1 667.98±600.15)/ml,P<0.05),其他指标以及女性的各项生化检验指标在三个时间段之间比较均无统计学差异(P>0.05)。无论男女与术前比较,术后3-5d和7-10d的BMI值及MNA评分均显著下降(男术后3-5d和7-10dBMI值(22.02±2.07)kg/m2和(21.45±2.89)kg/m2 vs术前(23.11±2.11)kg/m2,女术后3-5d和7-10d BMI值(20.77±2.08)kg/m2和(20.06±2.16)kg/m2 vs术前(21.04±1.99)kg/m2,男术后3-5d和7-10dMNA评分20.58±6.22和20.92±8.15 vs术前22.98±5.48,女术后3-5d和7-10d MNA评分(20.33±9.16)和(19.98±6.88)vs术前(23.12±6.26),P<0.05)。结论老年胃肠道肿瘤患者术后静息能量消耗与术前比较呈下降趋势,可能与术后BMI、血红蛋白、淋巴细胞总数及MNA评分下降有关。
Objective To observe the changes of resting energy metabolism in the elderly patients with gastrointestinal cancer during perioperative period. Methods Totally 73 patients with gastrointestinal cancer aged 65-80 years old were enrolled in this study. Their self-control study methods were used to measure resting energy metabolism before and 3 to 5 days after operation and 7 to 10 days after operation by MedGeM bedside metabolizer (restingenergy expenditure, REE), height, weight, body mass index (BMI), nutrition status assessed by MNA method, blood biochemical parameters and prealbumin and C-reactive protein were detected. Results There was no significant difference in REE between 3 and 5 days after operation in all patients with gastrointestinal tumors (postoperative 3-5d (4 869.07 ± 432.31) kJ / d vs preoperative (629.10 ± 421.68) kJ / d) The preoperative 3-5d (4 062.12 ± 502.49) kJ / d vs preoperative (3892.63 ± 488.29) kJ / d, (P> 0.05) The number of male patients with REE gastrointestinal tumor was significantly lower than that of the normal group (7 days to 7 days postoperatively (3 443.15 ± 385.02) kJ / d vs 4 340.22 ± 418.82 kJ / d and 4 600.47 ± 434.45 ) (kJ / d) at 7-10 days after operation (4 137.11 ± 347.21 kJ / d vs 5 012.36 ± 455.15 kJ / d and 3-5 days (5 091.66 ± 421.89) kJ / d after operation) (P <0.05). The number of bowel tumors in women was significantly lower (7 to 101 days (3 766.56 ± 388.08) kJ / d vs 4 180.08 ± 305.86 kJ / d and 4 to 47 days after surgery 416.47) kJ / d, P <0.05) .The hemoglobin values and total lymphocytes in male patients at 3-5 days and 7-10 days after operation were significantly decreased compared with preoperative values (131.07 ± 24.18), and (125.08 ± 23.82) g / L vs 147.79 ± 14.82 g / L preoperatively. The total number of lymphocytes (1 363.95 ± 570.76) / ml and (1 316.78 ± 589.66) / ml vs preoperative (6667.98 ± 600.15) / ml, P <0.05 ), Other indicators and biochemical indicators of women in the three time periods showed no significant difference (P> 0.05) .While male and female compared with preoperative, postoperative 3-5d and 7-10d BMI And MNA scores decreased significantly (postoperative 3-5d and 7-10dBMI (22.02 ± 2.07) kg / m2 and (21.45 ± 2.89) kg / m2 vs 23.11 ± 2.11 kg / m2 respectively 3-5min and 7-10d BMI (20.77 ± 2.08) kg / m2 and (20.06 ± 2.16) kg / m2 vs 21.04 ± 1.99 kg / m2 preoperatively, and 3-5 days and 7-10 days postoperatively. MNA score was 20.58 ± 6.22 and 20.92 ± 8.15 vs 22.98 ± 5.48 before operation and 3-5 days and 7-10 days after operation respectively (20.33 ± 9.16 and 19.98 ± 6.88 vs 23.22 ± 6.26, P <0.05). Conclusion The postoperative resting energy expenditure of elderly patients with gastrointestinal cancer is in a downward trend compared with that before operation, which may be related to the decrease of postoperative BMI, hemoglobin, total lymphocytes and MNA score.