目的:胰腺癌患者术前营养不良与术后不良预后相关。这项研究评估了当前实践对胰腺癌患者营养支持的有效性。
方法:在Isala诊所Zwolle进行的观察性多中心HPB网络研究,医学频谱Twente,吕沃登医疗中心,和格罗宁根大学医学中心在2021年10月至2023年5月之间。使用患者生成的主观整体评估(PG-SGA)问卷对计划进行手术的可疑胰腺恶性肿瘤患者进行营养不良筛查,并转诊给专门的营养师进行营养支持,包括胰腺酶替代疗法。饮食建议,和营养补充剂,以达到足够的热量和蛋白质摄入量。在基线,术前1天,术后3个月,对患者的营养状况和肌肉厚度进行了评估.
结果:该研究包括30名患者,其中12人(40%)在基线时被归类为营养不良(PG-SGA≥4)。与营养良好的患者相比,营养不良的病人更年轻,主要是女性,身体质量指数较高,尽管在过去的6个月里失去了更多的体重。所有营养不良患者和78%的营养良好患者都接受了营养支持。因此,术前观察到热量和蛋白质摄入量以及体重的增加.术后,尽管热量摄入进一步增加,蛋白质摄入量大幅减少,体重,并观察肌肉厚度。
结论:胰腺手术患者普遍存在营养不良。专职营养师的营养支持可有效改善患者的术前营养状况。然而,可以改善术后患者营养摄入充足的监测.
OBJECTIVE: Preoperative malnutrition is associated with poor postoperative outcomes in patients with pancreatic cancer. This study evaluated the effectiveness of current practice in nutritional support for patients with pancreatic cancer.
METHODS: Observational multicenter HPB network study conducted at the Isala Clinics Zwolle, Medical Spectrum Twente, Medical Center Leeuwarden, and University Medical Center Groningen between October 2021 and May 2023. Patients with a suspected pancreatic malignancy scheduled for surgery were screened for malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and referred to a dedicated dietician for nutritional support comprising pancreatic enzyme replacement therapy, dietary advice, and nutritional supplements to achieve adequate caloric and protein intake. At baseline, 1 day preoperatively, and 3 months postoperatively, the nutritional status and muscle thickness were evaluated.
RESULTS: The study included 30 patients, of whom 12 (40%) classified as malnourished (PG-SGA ≥ 4) at baseline. Compared to well-nourished patients, malnourished patients were younger, were predominantly female, and had a higher body mass index, despite having lost more body weight in the past 6 months. All malnourished patients and 78% of the well-nourished patients received nutritional support. Consequently, a preoperative increase in caloric and protein intake and body weight were observed. Postoperatively, despite a further increase in caloric intake, a considerable decrease in protein intake, body weight, and muscle thickness was observed.
CONCLUSIONS: Malnutrition is prevalent in patients undergoing pancreatic surgery. Nutritional support by a dedicated dietician is effective in enhancing patients\' preoperative nutritional status. However, postoperative monitoring of adequate nutritional intake in patients could be improved.