| Objective:To observe the changes of gastric cancer patients' resting energy expenditure by the metabolic cart,during the perioperative period,and to guide clinical treatment.Method:112 patients with gastric cancer were treated surgically in the Third Department of General Surgery,The Fourth Hospital of Hebei Medical University,during the period of 2016-3 to 2017-1.The patients' nutritional status were asscessed by using PG-SGA.The patients' resting energy expenditure(HBREE)were calculated with Harris-Benedict formula.Meanwhile,the patients' preoperative REE and the REE on postoperative day 1,3,7 were measured with metabolic cart.Result:1 General date1.1 Gender: 112 patients with gastric cancer,including males 95 cases of male and 17 cases of female,the ratio of male to female was 5.5:1.1.2 Age: average age is 59.2±9.5,from 23 to 78 years.1.3 Hight and Weight: average height was 66.8±10.6kg,average weight was66.8±10.6kg.1.4 Tumor location and size: 39 cases of upper gastric cancer,24 cases of middle gastric cancer,49 cases of lower gastric cancer.The tumor average size is 5.3±2.8cm,from 1 to 13 cm.1.5 TNM staging: 21 cases in stage?,21 cases in stage ? and 70 cases in stage ?.1.6 Surgical options: 96 cases with open surgery,and 16 cases with Laparoscopic surgery.1.7 Surgical method: Radical resection of proximal gastric resection in 10 cases,Radical resection of distal gastrectomy in 44 cases,Radical gastrectomy in 57 cases,and combined organ resection in 1 case.1.8 Operation time and bleeding volume: The operation time was from 70 to345 min,with an average of 208.1± 63.9min.Surgical bleeding volume of 20 ~400ml,the average bleeding was 102.3±69.6ml.2 Nutrition situation: Nutritional normal(A)was 50 cases,accounting for45%;moderate or suspicious malnutrition(B)was 50 cases,accounting for45%;severe malnutrition(C)was 12,accounting for 10%.Malnutrition(B +C)was 62 cases,accounting for 55%.3 Resting energy expenditure3.1 The relationship between HBREE and preoperative RRE: The HBREE calculated by HB formula was 1405.5±191.8kcal/d,the REE measured by metabolic cart was 1482.6±159.1kcal/d.The HBREE calculated by HB formula was about 5% lower than the REE measured by metabolic cart(P<0.05).3.2 The relationship between age and preoperative REE: The preoperative REE negatively correlated with age(r=-0.561,P=0.02).3.3 The relationship between gender and preoperative REE: Male patients' preoperative REE was 1506.9±146.2 kcal/d,female patients' preoperative REE was 1347.1±164.2 kcal/d.Male patients' preoperative REE was almost12% higher than female(P<0.05).3.4 The relationship between preoperative nutritional status and REE: The preoperative REE of well-nourished group(A)was 1527.3±166.9kcal/d,the preoperative REE of suspected malnutrition(B)was1455.1±153.0kcal/d,the preoperative REE of malnourished(C)was 1411.0±94.7kcal/d.The preoperative REE of well-nourished group(A)was obviously higher than patients with suspected malnutrition(B)and malnourished patients(C).Respectively,it was higher about 5%,8%(P=0.03,0.01).There was no obvious difference between the latter two group(P=0.30).3.5 The relationship between TNM staging and preoperative REE: The REE of stage?was 1507.2±197.3kcal/d,the REE of stage? was1494.8±142.7kcal/d,the REE of stage ? was 1471.6±152.2kcal/d.There was no obvious relation between TNM staging with the preoperative REE(F=0.48,P=0.62).3.6 The comparison between preoperative REE and the REE on postoperative day 1,3,7: The preoperative REE was 1482.6±159.1kcal/d,The REE on postoperative day 1 was 1262.9±198.6kcal/d,the REE on postoperative day 3was 1565.5±165.7kcal/d,the REE on postoperative day 7 was1475.3±172.2kcal/d.The REE on postoperative day 1 was about 14% lower than the preoperative REE(P=0.03).The REE on postoperative day 3 was about 6% higher than the preoperative REE(P=0.00).The REE on postoperative day 7 was roughly equal to the preoperative REE(P=0.57).3.7 The comparison between surgery time,bleeding volume,surgical options,surgical method and the REE on postoperative day 1,3,7: The REE of operation time ?208min on postoperative day 3 was 1562.4±142.3 kcal/d,the REE of operation time >208min on postoperative day 3 was 1597.0±177.2kcal/d.The REE of the group which did not exceed the average time of surgery,was slightly higher than the REE of the group which exceed the average time of surgery on the postoperative day 3.And there was no significant relation between REE and mean surgery time on postoperative day1 and 7.But there is no obvious relation between the postoperative REE and bleeding volume,surgical options,surgical method.Conclusion:1 Most preoperative patients with gastric cancer had malnutrition.2 The HBREE calculated by HB formula was lower the the REE measured by metabolic cart.3 The preoperative REE decreased with age,and it had a negative correlation.4 Male patients' preoperative REE was higher than female.5 The preoperative REE of well-nourished group(A)was obviously higher than patients with suspected malnutrition(B)and malnourished patients(C),and ther was no obvious difference between the latter two group.6 There was no obvious relation between TNM staging with the preoperative REE.7 The REE on postoperative day 1 was lower than the preoperative REE.The REE on postoperative day 3 was higher than the preoperative REE.The REE on postoperative day 7 was roughly equal to the preoperative REE.Metabolic cart is able to monitor the changes of gastric cancer patients' REE,and to guide nutritional treatment perioperatively.8 The REE on postoperative day 3 increased with the operation time,but there was no significant correlation between the REE and operation time on postoperative day 1 and 7.9 There was no obvious relation between the postoperative REE and bleeding volume,surgical options,surgical method. |
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