目的 调查食管癌患者围术期不同时期营养状态与相关因素。方法 60 例食管癌患者术后早期给予肠内营养，术前和术后12天进行患者主观整体评估，于术前、术后7 天和12 天监测患者的体质指数、上臂围、上臂肌围、肱三头肌皮 褶厚度，检测血清总蛋白、白蛋白、球蛋白、血红蛋白、总淋巴细胞计数、谷草转氨酶、谷丙转氨酶，并比较不同时期各 指标的差异，分析术前和术后 12 天营养不良的相关因素。结果 术前 PG-SGA 评分：营养良好（PG-SGA 0~1 分）的患者 2 例（ 3.3%），可疑营养不良（PG-SGA 2~3分）的患者11例（ 18.3%），中度营养不良（PG-SGA 4~8分）的患者31例（ 51.7%）， 重度营养不良（PG-SGA ≥ 9 分）的患者16 例（26.7%）；术后12 天 PG-SGA 评分：营养良好（PG-SGA 0~1 分）的患者 0例（0.0%），可疑营养不良（PG-SGA 2~3分）的患者0例（0.0%），中度营养不良（PG-SGA 4~8分）的患者6例（10.0%）， 重度营养不良（PG-SGA ≥ 9 分）的患者 54 例（90.0%）。与术前相比，术后 12 天 PG-SGA 评分显著增加（P ＜ 0.01）； 与术前相比，术后7天和术后12天总蛋白、白蛋白、血红蛋白、总淋巴细胞计数均有明显下降（P＜0.01），谷草转氨酶、 谷丙转氨酶有所上升（P ＜ 0.01）；与术后7 天相比，术后12 天总蛋白、球蛋白明显上升（P ＜ 0.05，P ＜ 0.01），白蛋 白有上升趋势，但无统计学意义（P ＞ 0.05）；与术前相比，术后7 天和12 天体质指数均下降，特别是术后7 天下降明显 （P ＜ 0.05），术后 7 天和 12 天上臂围、肱三头肌皮褶厚度均有下降，尤其术后 12 天下降较明显（P ＜ 0.05）；术前 PGSGA 评分与肱三头肌皮褶厚度呈明显负相关（P ＜ 0.01），术后12 天 PG-SGA 评分与上臂肌围、肱三头肌皮褶厚度呈明 显负相关（P ＜ 0.05，P ＜ 0.01）。结论 食管癌患者术前和术后均存在营养不良，且术后营养不良风险增加，而术后早期 给予肠内营养，可逐步改善患者的营养相关指标，但想恢复至术前水平，出院后的家庭营养是非常必要的。

Objective To investigate the nutritional status of esophageal cancer patients at different perioperative period and analyse the related factors malnutrition. Methods 60 patients with esophageal cancer were given early enteral nutrition support after operation. The nutritional status were evaluated by the patient-generated subjective global assessment (PG-SGA) before operation and the twelfth days after operation. Body mass index, arm circumference, arm muscle circumference, triceps skinfold thickness were monitored, and serum total protein, albumin and globulin, hemoglobin, total lymphocyte count, glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase were detected before operation, the seventh and twelfth days after operation. Compare the differences of each index in different periods and analyse the related factors of malnutrition before operation and the twelfth days after operation. Results PG-SGA scores before operation: 2 patients (3.3%) with good nutrition (PG-SGA 0~1), 11 patients (18.3%) with suspected malnutrition (PG-SGA 2~3), 31 patients (51.7%) with moderate malnutrition (PG-SGA 4~8), 16 patients (26.7%) with severe malnutrition (PG-SGA≥9) ; PG-SGA scores at the twelfth days after operation: 0 patients (0.0%) with good nutrition (PGSGA 0~1), 0 patients (0.0%) with suspected malnutrition (PG-SGA 2~3), 6 patients (10.0%) with moderate malnutrition (PG-SGA 4~8), 54 patients (90.0%)with severe malnutrition, and compared with before operation, the PG-SGA score increased significantly at the twelfth days after operation (P<0.01). Compared with preoperative values, serum total protein, albumin, hemoglobin and total lymphocyte count were significantly decreased (P<0.01), glutamic-oxalacetic transaminase and glutamic-pyruvic transaminase increased significantly (P<0.01). Compared with the seventh days after operation, total protein and globulin increased significantly at the twelfth days after operation (P<0.05, P<0.01), and albumin had a rising trend, but there was no statistical significance (P>0.05). Compared with before operation, body mass index decreased, especially at the seventh days after operation, arm circumference and triceps skinfold thickness were decreased at the seventh and twelfth days after operation, especially at the twelfth days after operation (P<0.05); the PG-SGA scores before operation were negatively correlated with triceps skinfold thickness (P<0.01), and the PG-SGA scores at the twelfth days after operation were negatively correlated with arm muscle circumference and triceps skinfold thickness (P<0.05, P<0.01). Conclusions The presence of malnutrition in patients with esophageal cancer before and after operation, and the risk of malnutrition was increased after the operation. Early postoperative enteral nutrition support can gradually improve thenutritional index of patients, but to restore the preoperative level, the family nutrition support after discharge is essential.