口腔颌面恶性肿瘤合并糖尿病患者围术期营养状况调查分析

doi:10.19439/j.sjos.2021.03.017

摘要/Abstract

摘要： 目的: 调查分析口腔颌面恶性肿瘤合并糖尿病患者围术期营养状况。方法: 收集接受手术治疗的口腔颌面恶性肿瘤合并糖尿病患者64例,并分别于术前、术后第1天、第3天、第7天清晨空腹抽取静脉血,检测血蛋白功能[血红蛋白（Hb）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）]、免疫功能[总淋巴细胞计数（L）、淋巴细胞百分比（L%）]、代谢相关指标[肌酐（Scr）、尿酸（UA）、尿素氮（BUN）、肾小球滤过率（eGFR_EPI_c）]以及炎症反应相关指标[白细胞（WBC）],调查患者术后第7天肠内营养液摄入情况,分析患者营养状况与住院时间相关性。采用SPSS 23.0软件包对数据进行统计学分析。结果: 术后各组患者血TP、ALB、PA及Hb水平与术前相比均显著降低（P<0.05）。术后第7天,TP水平显著高于术后第1天和第3天（P<0.05）;术后第3天血PA水平显著低于术后第1天（P<0.05）;血Hb水平在术后第7天与术后第3天水平均显著低于术后第1天（P<0.05）;术后各组血L水平与术前相比均显著降低（P<0.05）,术后各组逐渐升高,各组两两之间比较差异均有统计学意义（P<0.05）;术后各组血Scr与术前相比,均显著降低（P<0.05）;术后各组血UA均显著低于术前（P<0.05）,术后第3天显著低于术后第1天（P<0.05）;术后各组eGFR_EPI_c水平均显著高于术前（P<0.05）,术后第7天显著高于术后第1天（P<0.05）;术后血WBC均较术前显著升高（P<0.05）,术后第3天与术后第7天均显著高于术后第1天（P<0.05）。术后第7天,患者能量、蛋白质摄入量均显著低于目标推荐量（P<0.05）。术前BMI与术后第1天TP、ALB及术后第3天TP水平均存在正相关（P<0.05）;术前BMI与术后住院时间无直接相关性（P>0.05）;术后住院时间与年龄、术后第1天TP及ALB水平存在负相关（P<0.05）。结论: 口腔颌面恶性肿瘤合并糖尿病患者术后早期营养状况指标明显降低,能量、蛋白质摄入量均显著低于目标推荐量,术后住院时间与术后早期营养状况及年龄存在负相关。

关键词: 营养状况, 口腔颌面恶性肿瘤, 糖尿病, 围术期

Abstract: PURPOSE: To analyze the nutritional status of patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus during perioperative period. METHODS: Sixty-four patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus were collected. Fasting venous blood of patients was extracted on the morning of the day before surgery and then at the 1st, 3rd and 7th day after surgery, respectively. The hemoglobin (Hb), total protein (TP), pre-albumin (PA), lymphocyte count (L), creatinine (Scr), uric acid (UA), urea nitrogen (BUN), glomerular filtration rate (EGFR_EPI_C), white blood cells (WBC) of the patients were detected. The intake of enteral nutrition on the 7th day after operation was investigated. The correlation between nutritional status and the length of stay was analyzed. SPSS 23.0 software package was used for statistical analysis. RESULTS: Compared with the indicators before surgery, the values of TP, ALB, PA, Hb were decreased significantly after surgery in all groups(P<0.05). The level of TP on postoperative day 7 was significantly higher than that on postoperative day 1 and postoperative day 3(P<0.05). The PA level on the third day after surgery was significantly lower than that on the first day after surgery(P<0.05). The Hb level on the 7th and 3rd day after surgery was significantly lower than that on the 1st day after surgery (P<0.05). The level of L decreased significantly in each group after surgery compared with the level before surgery(P<0.05), and gradually increased in each group after surgery, with significant difference among each two groups (P<0.05). Compared with preoperative value, blood Scr was significantly decreased in all groups after surgery (P<0.05), the UA level after surgery was significantly lower than the preoperative level in all groups(P<0.05), and at the 3rd day after surgery was significantly lower than at the 1st day after surgery(P<0.05). After surgery, the eGFR_EPI_c level was significantly higher than the level before surgery in all groups (P<0.05), and at the 7th day after surgery was significantly higher than at the 1st day after surgery (P<0.05). The level of WBC in all patients after surgery was significantly higher than that before surgery(P<0.05), and the level at the 3rd and 7th day after surgery was significantly higher than that at the 1st day after surgery(P<0.05). At the 7th day after surgery, the energy and protein intakes of the patients were significantly lower than the recommendations. There was positive correlation between preoperative BMI and TP, ALB levels at the 1st postoperative day and the TP level at 3rd postoperative day(P<0.05). There was no direct correlation between preoperative BMI and the length of postoperative hospital stay (P>0.05). The length of postoperative hospital stay was negatively correlated with the age and negatively with TP and ALB levels at the 1st postoperative day(P<0.05). CONCLUSIONS: Early postoperative nutritional status of patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus decreased significantly. The energy and protein intakes of the patients are significantly lower than the recommendations. The length of postoperative hospital stay is negatively correlated with early postoperative nutritional status and age.

Key words: Nutritional status, Malignant oral and maxillofacial neoplasms, Diabetes mellitus, Perioperative period

中图分类号:

R739.8

孙娟, 张海峰, 唐雯, 刘希鹏, 赵安达. 口腔颌面恶性肿瘤合并糖尿病患者围术期营养状况调查分析[J]. 上海口腔医学, 2021, 30(3): 306-311.

SUN Juan, ZHANG Hai-feng, TANG Wen, LIU Xi-peng, ZHAO An-da. Investigation and analysis of perioperative nutritional status in patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus[J]. Shanghai Journal of Stomatology, 2021, 30(3): 306-311.

参考文献

[1] World Health Organization.Global status report on noncommunicable diseases 2014[R]. Geneva, Switzerland: World Health Organization, 2014.
[2] Bray F, Ferlay J, Soerjomataram I, et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[3] World Health Organization. NCD mortality and morbidity[OL]. Accessed on 26th April2020 at https://www.who.int/gho/ncd/mortality_morbidity/en/.
[4] Gong Y, Wei B, Yu L, et al.Type 2 diabetes mellitus and risk of oral cancer and precancerous lesions: a meta-analysis of observational studies[J]. Oral Oncol, 2015, 51(4): 332-340.
[5] 石汉平. 营养治疗是肿瘤的一线治疗[J]. 临床药物治疗杂志, 2019, 17(4): 20-25.
[6] Müller-Richter U, Betz C, Hartmann S, et al.Nutrition management for head and neck cancer patients improves clinical outcome and survival[J]. Nutr Res, 2017, 48: 1-8.
[7] Bassett MR, Dobie RA.Patterns of nutritional deficiency in head and neck cancer[J]. Otolaryngol Head Neck Surg,1983, 91(2): 119-125.
[8] 吴蓓雯, 曹伟新. 主观综合性营养评价法在住院病人营养状况及预后评价中的作用[J]. 肠外与肠内营养, 2008, 15(3): 183-185.
[9] 苏波. 住院患者营养状况评价及临床应用[D]. 上海: 第二军医大学, 2003.
[10] 郭传瑸, 马大权, 章魁华,等. 口腔颌面部恶性肿瘤患者营养状况调查分析[J]. 中华口腔医学杂志, 1994,29(3):143-145.
[11] American Diabetes Association.Classification and diagnosis of diabetes: standards of medical care in diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1): S13-S28.
[12] 宋永海, 孙玉环, 车宗刚. 头颈肿瘤患者加速康复外科方案[J]. 中国口腔颌面外科杂志, 2019, 17(2): 186-189.
[13] CSCO肿瘤营养治疗专家委员会. 恶性肿瘤患者的营养治疗专家共识[J]. 临床肿瘤学杂志, 2012, 17(1): 59-73.
[14] Arends J, Bachmann P, Baracos V, et al.ESPEN guidelines on nutrition in cancer patients[J]. Clin Nutr, 2017, 36(1): 11-48.
[15] Dort JC, Farwell DG, Findlay M, et al.Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(3): 292-303.
[16] Gellrich NC, Handschel J, Holtmann H, et al.Oral cancer malnutrition impacts weight and quality of life[J]. Nutrients, 2015, 7(4): 2145-2160.
[17] 黄春珍, 侯凌烨, 石慧娟, 等. 术前营养风险评估与干预对口腔癌患者预后的效果评价[J]. 中国实用护理杂志, 2019, 35(4): 292-297.
[18] 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.
[19] Hopanci Bicakli D, Ozkaya Akagunduz O, Meseri Dalak R, et al.The effects of compliance with nutritional counselling on body composition parameters in head and neck cancer patients under radiotherapy[J]. J Nutr Metab, 2017: 8631945.
[20] Thompson L.World Health Organization classification of tumours: pathology and genetics of head and neck tumours[J]. Ear Nose Throat J, 2006, 85(2): 74-75.
[21] Correia MI, Caiaffa WT, da Silva AL, et al. Risk factors for malnutrition in patients undergoing gastroenterological and hernia surgery: an analysis of 374 patients[J]. Nutr Hosp, 2001, 16(2): 59-64.
[22] 李洪丽, 柯红, 聂成刚,等. 口服营养在肿瘤治疗中的应用价值[J]. 中国社区医师, 2019, 35(4): 13-14.