Wiel E, Costecalde M E, Séguy D, Merrot O, Erb C, Chevalier D, Vallet B
Clinique d'anesthésie-réanimation chirurgicale II, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
Ann Fr Anesth Reanim. 2005 Jun;24(6):600-6. doi: 10.1016/j.annfar.2005.02.029.
To assess the perioperative evolution of the nutritional status of head and neck surgical patients.
Prospective, descriptive case series.
Fifty-four patients candidates for total or partial laryngectomy for malignancy of the neck tract without a past of neck surgery. The nutritional status of all patients hospitalized for total pharyngolaryngectomy, total or partial laryngectomy was assessed by 1) clinical parameters including weight (W), weight variation (WV, percentage of loss), Body Mass Index (BMI), triceps skin fold measurement (T), midarm circumference (M), and 2) biological parameters such as serum albumin (SA), transthyretin (TTR), lymphocytes (Ly). These parameters were noted at the time of diagnostic laryngoscopy (T1), the day before surgery (T2), and 10 days afterward (T3) when patients were authorized to eat normally. All patients had enteral nutrition (EN) support (35 kcal/kg/day) starting at D1 and for 10 days afterward. Only complete data per patient were analyzed.
24 patients were excluded. During the 21 days [7-53] preoperative period (T1-T2), WV was (6.6% [-8,1-+20.0] [T2] vs. 4.7% [-12,9-+20.0] [T1], p<0.05) without difference in T and M. In the postoperative period (T2-T3), all parameters worsened, except T, with: WV (8.2% [-8,1-+20.0] [T3], p<0.05 vs T2), M (27.4 cm [20.0-37.0] [T3] vs 28.3 cm [20.5-39.0] [T2], p<0.05) et TTR (0.21 mg/l [0.09-0.36] [T3] vs. 0.27 mg/l [0.08-0.45] [T2], p<0.05). BMI was 22.9 [15.2-36.7] (T1) vs 22.9 [15.2-35.3] (T2), NS and 22.1 [15.0-34.9] (T3), p<0.05 vs (T2).
The nutritional status in malignancy head and neck surgical patients seems to be best assessed by loss weight. It worsened mainly during the postoperative period even if a well-conducted EN was performed as defined by the French consensus conference.
评估头颈外科手术患者围手术期营养状况的变化。
前瞻性描述性病例系列研究。
54例因颈部恶性肿瘤拟行全喉或部分喉切除术且既往无颈部手术史的患者。对所有因全喉咽切除术、全喉或部分喉切除术住院的患者，通过以下方式评估营养状况：1）临床参数，包括体重（W）、体重变化（WV，体重减轻百分比）、体重指数（BMI）、肱三头肌皮褶厚度（T）、上臂围（M）；2）生物学参数，如血清白蛋白（SA）、转甲状腺素蛋白（TTR）、淋巴细胞（Ly）。这些参数在诊断性喉镜检查时（T1）、手术前一天（T2）以及术后10天患者可正常进食时（T3）记录。所有患者从第1天开始接受肠内营养（EN）支持（35 kcal/kg/天），持续10天。仅分析每位患者的完整数据。
24例患者被排除。在术前21天[7 - 53天]（T1 - T2）期间，体重变化（WV）为（[T2时6.6% [-8.1 - +20.0]] 对比 [T1时4.7% [-12.9 - +20.0]]，p<0.05），T和M无差异。在术后期间（T2 - T3），除T外所有参数均恶化，具体如下：体重变化（WV）（[T3时8.2% [-8.1 - +20.0]]，与T2相比p<0.05），上臂围（M）（[T3时27.4 cm [20.0 - 37.0]] 对比 [T2时28.3 cm [20.5 - 39.0]]，p<0.05）以及转甲状腺素蛋白（TTR）（[T3时0.21 mg/l [0.09 - 0.36]] 对比 [T2时0.27 mg/l [0.08 - 0.45]]，p<0.05）。体重指数（BMI）在T1时为22.9 [15.2 - 36.7]，T2时为22.9 [15.2 - 35.3]，无显著差异，T3时为22.1 [15.0 - 34.9]，与T2相比p<0.05。
头颈恶性肿瘤手术患者的营养状况似乎通过体重减轻来评估最为合适。即使按照法国共识会议的定义进行了良好的肠内营养支持，其营养状况仍主要在术后恶化。
