| Objectives:To study and understand the clinical application status of Immunonutritional Support in the perioperative period of patients with esophagus cancer,analyze the effect of Immunonutritional Support on clinical outcomes of patients,and provide clinical references for further construction of evidence-based perioperative immunenutrition support program for patients with esophageal cancer.Methods:For the sake of a cross-sectional study,a convenience sampling of esophagus cancer patients,who accepted immunonutritional support in perioperative period and were admitted in an upper first-class tumor hospital in a province from January to December in 2018,was implemented.Taken as the study objects,the patients were surveyed using general information questionnaire,nutritional risk screening 2002 scale(NRS2002),body mass index(BMI)and Clavien-Dindo complication evaluation system.Use Excel to establish the database and manage the data,and use SPSS23.0 software for statistical description,independent sample t test and(or)one-way ANOVA?chi-square test?rank sum test?multiple linear regression analysis?ordered logistics regression analysis and Spearman correlation analysis.Results:1.Current status and single factor analysis of perioperative immunenutritional support in patients with esophageal cancer.Timing of immunonutritional support:In this study,65.4%of the 176 patients began to receive immunonutritional support after surgery,and 34.6%of the patients applied immunonutritional support during the perioperative period.There was no statistically significant difference from the basic data(P>0.05).Immune nutrition support approach:57.4%of the 176 patients in this study used parenteral nutrition(PN)combined with oral nutritional supplement(ONS),and 42.6%used parenteral nutrition(PN)combined with enteral tube feeding(TF);The difference of immune nutrition support approach which was caused by the difference of preoperative obstruction degree was statistically significant(P<0.05).However,there was no statistically significant difference in gender,age,marital status,education,occupation,monthly income,payment of medical expenses,lesion location,surgical procedure,pathological type,body mass index(BMI),nutritional risk(NRS),etc.(P>0.05).Nutrients used in immuno-nutritional support:Immuno-nutritional preparations used in the 176 patients included alanyl glutamine,coenzyme complex and enteral nutritional suspension(TPF),where alanyl glutamine was applied to most patients(96 cases,54.5%),followed by TPF(38,21.6%)and coenzyme complex(33,18.8%)in succession,and few patients used the above preparations in a combined way.The difference between nutrients in immuno-nutritional support in the aspect of monthly income was of statistical significance(P<0.05).2.Multivariate analysis of postoperative hospital stay for patients with esophageal cancer perioperative immune nutrition support Regression analysis of influencing factors of postoperative hospital stay for patients with esophageal cancer perioperative immunonutritional support and suggested that the surgical procedure and the timing of immunonutritional therapy were related influencing factors for postoperative hospital stay(R~2=0.197,The regression coefficients were 1.775,-0.184,P<0.05,respectively),Thoracotomy and only postoperative application of immune nutrition support are risk factors for the increase of hospitalization time after operation.Analysis of the correlation between the status of immunonutritional support and the length of hospital stay showed that:There was a negative correlation between the timing of immune nutrition support(r=-0.296,P<0.001)and the length of postoperative hospital stay.There was a positive correlation between the timing of immune nutrition support(r=-0.195,P=0.013)and the length of postoperative hospital stay.Perioperative application of immune nutritional support,parenteral nutrition combined with oral nutrition(PN+ONS)is more beneficial to shorten the postoperative hospital stay.3.Multi-factor analysis of the total hospitalization time of patients with esophageal cancer perioperative immune nutrition support Regression analysis of the factors affecting the total hospitalization time of patients with esophageal cancer perioperative immunonutritional support suggested that:age,path and timing of immunonutritional support were related influencing factors of total hospitalization time(R~2=0.197,The regression coefficients were 1.318,-1.714,0.486,P<0.05,respectively),Elderly patients,only postoperative application of immune nutrition support and application of enteral feeding(TF)are risk factors for the increase of patients'total hospitalization time.Analysis of the relationship between immune nutritional support and total length of stay showed that:There was a negative correlation between the timing of immune nutrition support(r=-0.171,P=0.031)and the total length of hospitalization,and a positive correlation between the route of Immune Nutrition Support(r=0.223,P=0.005)and the total length of hospitalization.Perioperative application of immunenutritional support,parenteral nutrition combined with oral nutrition(PN+ONS)is more conducive to shorten the total length of hospital stay.4.Multi-factor analysis of postoperative complications of patients with esophageal cancer perioperative immunonutritional support Regression analysis of influencing factors of postoperative complications of immunonutritional support in patients with esophageal cancer suggests:age(OR=1.365,P<0.05),education level(OR=0.973,P<0.05),nutrition risk(NRS)score(OR=0.113,P<0.05),immunonutrition therapy approach(OR=1.662,P<0.05)was related to the occurrence of postoperative complications,The elderly,the education level of junior high school and below,the nutritional risk before operation,and the application of enteral feeding(TF)are the risk factors for postoperative complications of esophageal cancer patients receiving immune nutrition support during perioperative period.Analysis of the relationship between immunenutritional support and postoperative complications showed that:There was a positive correlation between postoperative complications and the Immune Nutrition Support Pathway(r=0.132,P=0.031).Parenteral nutrition combined with oral nutrition(PN+ONS)is more beneficial to reduce postoperative complications.Conclusions:1.The timing of immunenutritional support for patients with esophageal cancer during perioperative period mainly includes postoperative immunonutritional support and perioperative immunonutritional support.At present,most patients with esophageal cancer surgery still apply immunonutritional support only after surgery;Parenteral nutrition combined with oral nutritional supplement(PN+ONS)or parenteral nutrition combined with enteral tube feeding(PN+TF),PN+ONS is still the main support path for perioperative immunonutrition of esophageal cancer,The degree of obstruction before operation affects the choice of immune and nutritional support approaches;immune-type nutritional preparations include alanyl-glutamine,complex coenzyme,enteral nutrition suspension(TPF),And that proportion of single application is high than that of combined application,The degree of obstruction before operation and monthly income affect the choice of preparation.2.The timing and route of immunenutrition support affect the clinical outcome of esophageal cancer surgery patients.Perioperative application of immune nutritional support is more conducive to shortening the hospitalization time of patients than only postoperative application of immune nutritional support.Parenteral nutrition combined with oral nutrition supplement(PN+ONS)is better than parenteral nutrition combined with enteral tube feeding(PN+TF)in shortening hospitalization time and reducing postoperative complications. |
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