nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg journalInfo journalinfonormal searchdiv searchzone qikanlogo popupnotification paper paperNew
2023, 09, v.46 1262-1266
多学科协作诊治模式下营养干预在老年消化系统疾病患者围术期的应用
基金项目(Foundation): 国家重点研发项目(2018YFC2001804)
邮箱(Email): 13565800069@163.com;
DOI:
发布时间: 2023-09-15
出版时间: 2023-09-15
移动端阅读
摘要:

目的 探讨多学科协作诊治(MDT)模式下的营养干预对老年消化系统手术患者围术期的干预效果。方法 选取2021年1月-2022年1月收治于新疆维吾尔自治区人民医院微创外科的109例老年消化道手术患者为研究对象,根据患者能否接受MDT将其分为MDT组(53例)与非MDT组(56例)。比较两组患者营养、炎症相关指标水平,以及术后并发症发生情况等。结果 治疗后,MDT组和非MDT组总蛋白和白蛋白水平均较治疗前升高(P<0.05),且MDT组总蛋白和白蛋白水平与非MDT组比较,差异均有统计学意义(P<0.05)。治疗后,MDT组和非MDT组白细胞计数(WBC)、C反应蛋白(CRP)、白介素-6(IL-6)均较治疗前下降,25-羟基维生素D(25-OH-VD)水平较治疗前升高,差异均有统计学意义(P<0.05)。治疗后,MDT组WBC、25-OH-VD、CRP、IL-6、降钙素原(PCT)等炎症相关指标与非MDT组比较,差异均有统计学意义(P<0.05)。MDT组患者总住院天数、总住院费用均低于非MDT组患者,差异有统计学意义(P均<0.05)。结论 MDT模式下的营养干预能有效改善老年消化系统手术患者的术后营养状态及炎症状态,缩短患者的住院时间,减少其住院费用。

Abstract:

Objective To study the effect of nutritional intervention under multi-disciplinary treatment(MDT) mode on the perioperative intervention in elderly patients with digestive system surgery. Met-hods A total of 109 elderly patients underwent gastrointestinal surgery admitted to the hospital from January 2021 to January 2022 were selected as the research subjects. The patients were divided into an MDT group(53 cases) and a non MDT group(56 cases) based on their ability to accept MDT. The levels of nutrition, inflammation and postoperative complications were compared between the two groups. Results After the treatment, the total protein and albumin levels in the MDT group and non MDT group were increased compared to before the treatment(P<0.05), and the total protein and albumin levels in the MDT group were statistically significant compared to the non MDT group(P<0.05). After the treatment, the WBC, CRP and IL-6 levels in the MDT group and non MDT group were decreased compared to before the treatment, while the levels of 25-OH-VD were increased compared to before the treatment, with statistical significance(P<0.05). After the treatment, there were statistically significant differences in inflammation related indicators such as WBC, 25-OH-VD, CRP, IL-6 and PCT between the MDT group and the non MDT group(P<0.05). The total hospitalization days and total hospitalization expenses of the patients in the MDT group were lower than those of the patients in the non MDT group, with statistically significant differences(P<0.05). Conclusion The nutritional intervention under MDT mode can effectively improve the nutritional status and inflammatory status in elderly patients after digestive system surgery, reduce the hospitalization time and costs of the patients.

参考文献

[1] 郁阿翠,陈喜,杨萌娜,等.老年人营养不良状况及影响因素分析[J].实用老年医学,2022,36(8):822-826,832.

[2] 张翠翠,赵静.老年消化道恶性肿瘤患者营养不良影响因素分析及肠内外营养支持干预效果[J].肿瘤药学,2021,11(6):769-774.

[3] ARVANITAKIS M,OCKENGA J,BEZMAREVIC M,et al.ESPEN guideline on clinical nutrition in acute and chronic pancreatitis[J].Clin Nutr,2020,39(3):612-631.

[4] WEIMANN A,BRAGA M,CARLI F,et al.ESPEN guideline:clinical nutrition in surgery[J].Clin Nutr,2017,36(3):623-650.

[5] 中华医学会肠内肠外营养学分会,中国医药教育协会炎症性肠病专业委员会.中国炎症性肠病营养诊疗共识[J].中华消化病与影像杂志(电子版),2021,11(1):8-15.

[6] SCHUETZ P,FEHR R,BAECHLI V,et al.Individualised nutritional support in medical inpatients at nutritional risk:a randomised clinical trial[J].Lancet,2019,393(10188):2312-2321.

[7] 毛一晴,康定鼎,张博文,等.国内外多学科团队诊疗模式研究进展[J].中国医院,2022,26(3):18-21.

[8] LAMPRELL K,ARNOLDA G,DELANEY G P,et al.The challenge of putting principles into practice:Resource tensions and real-world constraints in multidisciplinary oncology team meetings[J].Asia Pac J Clin Oncol,2019,15(4):199-207.

[9] 唐通军,李丹,曾爱红,等.多学科协作诊疗模式在公立医院行政管理中的探索[J].中华医院管理杂志,2019,35(3):262-264.

[10] 丁如梅,汤靓,范静,等.胰十二指肠切除术后营养不良的危险因素[J].肝胆胰外科杂志,2022,34(9):550-555.

[11] 滕蛟,吴瑞乔.老年胃肠道肿瘤病人术前营养支持治疗研究进展[J].安徽医药,2022,26(11):2182-2186.

[12] 黄兆晶,刘红,何兴月,等.基于老年综合评估的多学科营养管理模式在老年病房中的应用研究[J].实用老年医学,2023,37(1):92-95.

[13] 董彦平.2018年-2019年某中医院老年住院患者疾病构成分析[J].新疆医学,2021,51(6):697-699.

[14] LIAO C K,CHERN Y J,HSU Y J,et al.The clinical utility of the geriatric nutritional risk index in predicting postoperative complications and long-term survival in elderly patients with colorectal cancer after curative surgery[J].Cancers,2021,13(22):5852.

[15] SUGAWARA K,YAMASHITA H,URABE M,et al.Geriatric nutritional index influences survival outcomes in gastric carcinoma patients undergoing radical surgery[J].J Parenter Enteral Nutr,2021,45(5):1042-1051.

[16] 崔红元,朱明炜,陈伟,等.中国老年住院患者营养状态的多中心调查研究[J].中华老年医学杂志,2021,40(3):364-369.

[17] 郝红梅,黄海玲,张微,等.慢性心力衰竭患者营养不良风险列线图预测模型的构建与验证[J].现代预防医学,2022,49(17):3130-3135.

[18] 吴寒寒,蒋建华,程靖,等.老年营养风险指数与老年胃癌患者围手术期康复的关系[J].安徽医科大学学报,2022,57(11):1816-1820.

[19] 邓照军,倪志,陈明霞.存在营养风险的原发性肝癌患者术前营养支持的效果及对免疫功能的影响[J].肝脏,2019,24(3):302-304.

[20] JIANG J H,OUYANG J,LIU S H,et al.The prognostic impact of pretreatment anemia in patients with gastric cancer and nonhypoalbuminemia undergoing curative resection:a retrospective study[J].Ann Transl Med,2021,9(13):1046.

[21] 谢敏华,雷霞,王春,等.多学科营养干预在高甘油三酯血症急性胰腺炎中的应用效果观察[J].中国现代医生,2021,59(34):48-51.

基本信息:

中图分类号:R57

引用信息:

[1]夏伊达·肖开提,姚俊英,迪拉热·迪里木拉提,等.多学科协作诊治模式下营养干预在老年消化系统疾病患者围术期的应用[J].新疆医科大学学报,2023,46(09):1262-1266.

基金信息:

国家重点研发项目(2018YFC2001804)

发布时间:

2023-09-15

出版时间:

2023-09-15

检 索 高级检索

引用

GB/T 7714-2015 格式引文
MLA格式引文
APA格式引文