符合和不符合指南标准营养支持对有营养风险外科手术患者临床结局的影响

　　2016年8月19日，英国《生物医学中心》旗下《营养杂志》在线发表南方医科大学武汉临床医学院、广州军区武汉总医院、昆明医科大学第二附属医院、云南省外科临床营养研究中心的前瞻队列研究报告（通信作者：卢绮萍、徐鹏远），探讨了营养支持对有营养风险且接受符合及不符合指南标准营养支持患者临床结局的影响。

　　该前瞻队列研究从2010年2月至2012年6月在昆明医科大学附属第二医院共入组525例住院患者。研究方案经大学伦理委员会批准，患者签署知情同意书。收集的临床数据包括营养风险筛查、肠外肠内营养实施、手术信息、并发症和住院天数。

　　结果发现，接受符合与不符合指南标准营养支持的患者相比，感染并发症发生率较低（17.1%比26.9%，P=0.01）。亚组分析显示，接受肠外营养联合肠内营养≥7天，与仅接受肠外营养≥7天或接受营养支持＜7天或＜10kcal/kg/d相比，感染并发症发生率显著较低（P=0.001）。二元逻辑回归分析显示，排除混杂因素后，对有营养风险患者进行符合指南标准的营养支持是并发症的防护因素（比值比：0.870，P＜0.002）。

　　因此，对于腹部手术后有营养风险的患者，符合营养指南推荐的营养支持（尤其联合肠外肠内营养≥7天的方案）可能降低感染并发症的发生率，值得推荐；但是，需要设计良好的试验证实该结果。不符合指南标准的营养支持不应被临床考虑。

Nutr J. 2016 Aug 19;15(1):78.

Impact of nutritional support that does and does not meet guideline standards on clinical outcome in surgical patients at nutritional risk: a prospective cohort study.

Sun DL, Li WM, Li SM, Cen YY, Lin YY, Xu QW, Li YJ, Sun YB, Qi YX, Yang T, Lu QP, Xu PY.

Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070, China; Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China; Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101, China.

OBJECTIVE: To investigate the impact of nutritional support on clinical outcomes in patients at nutritional risk who receive nutritional support that meets guideline standards and those who do not.

METHODS: This prospective cohort study enrolled hospitalized patients from the Second Affiliated Hospital of Kunming Medical University from February 2010 to June 2012. The research protocols were approved by the university's ethics committee, and the patients signed informed consent forms. The clinical data were collected based on nutritional risk screening, administration of enteral and parenteral nutrition, surgical information, complications, and length of hospital stay.

RESULTS: During the study period, 525 patients at nutritional risk were enrolled in the cohorts. Among patients who received nutritional support that met the guideline standards (Cohort 1), the incidence of infectious complications was lower than that in patients who did not meet guideline standards (Cohort 2) (17.1 % vs. 26.9 %, P = 0.01). Subgroup analysis showed that individuals who received a combination of parenteral nutrition (PN) and enteral nutrition (EN) for 7 or more days had a significantly lower incidence of infectious complications (P = 0.001) than those who received only PN for 7 or more days or those who received nutritional support for less than 7 days or at less than 10 kcal/kg/d. Binary logistic regression analysis showed that, after adjusting for confounding factors, nutritional support that met guideline standards for patients with nutritional risk was a protective factor for complications (OR: 0.870, P < 0.002).

CONCLUSIONS: In patients at nutritional risk after abdominal surgery, nutritional support that meets recommended nutrient guidelines (especially regimens involving PN + EN ≥ 7 days) might decrease the incidence of infectious complications and is worth recommending; however, well-designed trials are needed to confirm our findings. Nutritional support that does not meet the guideline standards is considered clinically undesirable.

KEYWORDS: Abdominal surgery patients; Guidelines; Logistic regression analysis; Nutritional risk; Outcome

PMID: 27543156

PMCID: PMC4991079

DOI: 10.1186/s12937-016-0193-6