目的 探讨加速康复外科中，营养风险筛查2002在结直肠癌患者围术期营养变化中的评估作用，并观察其临床应用效果及对此类患者营养治疗的指导意义。方法 根据定点连续抽样法选取2018年4月至2019年4月新入院、未经放化疗处理的围术期结直肠癌患者189例，入院24h和出院24h内均完成营养风险筛查2002。记录患者临床资料、进行人体物理指标测量和血红蛋白、血清白蛋白、前白蛋白的实验室检查，记录患者在住院期间营养治疗的应用状况，根据营养风险筛查 2002结果比较术前行与未行营养治疗患者及相关营养指标、术后康复情况。结果 所有患者全部完成营养风险筛查2002评估，动态营养风险筛查工具适用率高达100.00%。营养风险筛查结果显示，189例结直肠癌患者中，92例（48.68%）术前存在营养风险，其中30例术前给予营养治疗的患者术后康复情况优于术前未接受营养治疗的62例患者。本次研究患者术后营养治疗率为100%，其中肠内营养治疗应用比例较高。入院时营养筛查评分≥3分无营养治疗患者和入院时营养风险筛查 2002评分<3分患者在出院时的白蛋白、前白蛋白水平明显低于入院时。结论 术前营养风险筛查提示结直肠肿瘤患者入院时营养风险发生率较高，术前接受营养治疗可在一定程度上对术后康复有益，围术期过程中应及时合理予以营养治疗，改善患者预后。出院时患者营养风险有增加趋向，应重视患者出院时的营养风险筛查和评估。
Objective To assess the changes of perioperative nutritional risk and clinical applicability by dynamic Nutritional Risk Screening (NRS 2002), and to observe the conditions of nutrition support so as to the explore the role of dynamic NRS 2002 in guidance of perioperative nutritional support. Methods A total of 189 perioperative colorectal cancer patients without chemoradiotherapy on admission from April 2018 to April 2019 were selected by fixed place of continuous sampling. Dynamic nutritional risk screening was performed by NRS 2002 for patients at 24h after admission and within 24h after discharge. Clinical data, measurement of human physical indicators and indicators of laboratory examinations such as hemoglobin, serum albumin and prealbumin were recorded. Meanwhile, the condition of nutritional support of patients during hospital stay was recorded, related nutritional indicators and postoperative rehabilitation of patients with or without preoperative nutritional support were compared according to the screening results. Results All the 189 colorectal cancer patients enrolled in the study completed the NRS 2002 assessment, with an applicability rate of 100.00%. Nutritional risk screening results showed that there were 92 colorectal cancer patients (48.68%) with preoperative nutrition risk, among whom 30 patients (32.61%) received preoperative nutrition support, and their rehabilitation conditions were better than 62 patients without preoperative nutrition support. The postoperative nutrition support rate of the patients in the study was 100%. However, the proportion of patients with enteral nutrition support accounted for the highest, and their levels of albumin, prealbumin and hemoglobin at discharge were significantly lower when compared to the results of admission. Conclusions Preoperative nutritional risk screening indicates that patients with colorectal cancer have a higher incidence of nutritional risk for admission. Therefore, preoperative nutrition support is favorable for the rehabilitation of patients, perioperative nutrition support can improve their prognosis. Besides, nutritional risk screening and assessment at discharge are of great significance due to the increased trend of nutritional risk.
1.Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery：a systematic review and meta-analysis. Gastroenterology.2018；155：391-410.
2.Bozzetti F, Mariani L, Vullo SL, et al. Erratum to：the nutritional risk in oncology：a study of 1453 cancer outpatients. Supportive Care in Cancer.2012； 20(8)：1929.
3.中华医学会肠外肠内营养学分会.成人围手术期营养支持指南. 中华外科杂志.2016；54 (9)：641-657.
4.Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002)：a new method based on an analysis of controlled clinical trials. Clin Nutr.2003；22(3)：321-336.
5.刘淼,朱珍,律方.消化道肿瘤患者围手术期的营养支持治疗措施. 中华胃肠外科杂志.2016； 19(7)：830-832.
6.周建平,刘刚.结直肠癌病人围手术期营养支持争议与共识. 中国实用外科杂志.2018；38(3)：285-289.
7.中华医学会肠外肠内营养学分会“营养风险-营养不足-支持-结局-成本/效果比(NUSOC)”多中心数据共享协作组.营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版). 中华临床营养杂志.2018；(3)：131-135.
8.中华医学会肠外肠内营养学分会.肿瘤患者营养支持指南.中华外科杂志.2017；55(11)：801-829.
9.中华医学会肠外与肠内营养学分会.临床诊疗指南：肠外肠内营养学分册. 北京：人民卫生出版社,2008.
10.Zhu MW, Wei JM, Chen W, et al. Nutritional risk and nutritional status at admission and discharge among Chinese hospitalized patients： a prospective, nationwide, multicenter study. J Am Coll Nutr. 2017；36(5)：357-363.
11.Zhang H, Wang Y, Jiang ZM, et al. Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk： a prospective cohort study with propensity score matching. Nutrition.2017；37：53-59.
12.McClave SA, Taylor BE, Martindale RG, et al. American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient：Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr.2016；40(2)：159-211.
13.McClave SA, Martindale RG, Rice TW, et al. Feeding the critically ill patient. Crit Care Med.2014；42(12)：2600-2610.
14.Willcutts KF, Chung MC, Erenberg CL, et al. Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery. Ann Surg. 2016；264(1)：54-63.
15.Sun Zhen, Kong Xin-Juan, Jing Xue, et al. Nutritional risk screening 2002 as a predictor of postoperative outcomes in patients undergoing abdominal surgery：a systematic review and meta-analysis of prospective cohort studies. PLoS One.10(7)：e0132857.
16.Aarts MA, Rotstein OD, Pearsall EA, et al. Postoperative ERAS interventions have the greatest impact on optimal recovery：experience with implementation of ERAS across multiple hospitals. Anna Surg.2018；267：992-997.
17.Mariette C. Role of the nutritional support in the ERAS programme. J visc surg.2015； 152：S18-S20.
18.Weimann A, Braga M, Carli F, et al. ESPEN guideline： clinical nutrition in surgery. Clin nutr.2017；36(3)：623-650.
19.Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-an ESPEN consensus statement. Clin nutr.2015；34(3)：335-340.
20.Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise,on outcomes of patients who undergo colorectal surgery：a systematic review and meta-analysis. Gastroenterology.2018；155：391-410.
21.Bachmann J, Müller T, Schrder A, et al. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer. Medical oncology.2015；32(7)：201.
22.Beck A, Andersen UT, Leedo E, et al. Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome：a randomised controlled trial. Clin Rehabil.2015；29(11)：1117-1128.
23.Yang R, Tao W, Chen Y, et al. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy：a meta-analysis. Int J Surg.2016；36：274-282.
24.石汉平,许红霞,李苏宜, 等. 中国抗癌协会肿瘤营养与支持治疗专业委员会.营养不良的五阶梯治疗.肿瘤代谢与营养电子杂志.2015；2(1)：29-33.
25.Aarts MA, Rotstein OD, Pearsall EA, et al. Postoperative ERAS interventions have the greatest impact on optimal recovery：experience with implementation of ERAS across multiple hospitals. Anna surg.2018；267(6)：992-997.
26.项琦,李志刚,丁硕, 等. 某三级甲等医院院肿瘤患者肠外营养处方使用情况的横断面调查. 中华临床营养杂志.2017；25(2)：99-103.
27.中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志.2018；38(1)：1-20.
28.Mrabti H, Amziren M, ElGhissassi I, et al. Quality of life of early stage colorectal cancer patients in Morocco.BMC gastroenterology.2016；16(1)：131.
