营养猫方案改善加速康复外科中老年结直肠手术患者的身体成分和临床结局：一项回顾性队列研究。
NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study.
机构信息
UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
UOC di Chirurgia Generale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
出版信息
Nutrients. 2021 May 23;13(6):1781. doi: 10.3390/nu13061781.
BACKGROUND
A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program.
METHODS
302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into "NutriCatt + ERAS" ( = 166) or "standard ERAS" patients ( = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS ( = 0.03) and severe complications ( = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01-0.56; = 0.009).
CONCLUSIONS
The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.
背景
身体成分较差在老年患者中很常见，对围手术期结局有负面影响。我们评估了围手术期营养方案（NutriCatt）对采用 ERAS 方案的大容量中心接受结直肠手术的老年患者的身体成分和临床结局的影响。
方法
2015 年至 2020 年共确定了 332 名老年（>75 岁）患者中的 302 名。根据他们的依从性，将患者分为“NutriCatt+ERAS”（=166）或“标准 ERAS”患者（=136）。评估了接受 NutriCatt+ERAS 治疗的患者的人体测量和生物电阻抗分析数据。比较了两组之间的并发症、住院时间（LOS）和其他术后结局。在 NutriCatt+ERAS 患者中，相位角（入院前与入院时：4.61 ± 0.79 比 4.84 ± 0.85；=0.001；入院前与出院时：4.61 ± 0.79 比 5.85 ± 0.73；=0.0002）和细胞内液（入院前与入院时：22.4 ± 5.6 比 23.2 ± 5.7；=0.03；入院前与出院时：22.4 ± 5.6 比 23.1 ± 5.8；=0.02）显著改善。与标准 ERAS 患者相比，NutriCatt+ERAS 患者的 LOS 较短（=0.03）和严重并发症较少（=0.03）。回归分析证实了 NutriCatt 方案对严重并发症的保护作用（OR 0.10，95%CI 0.01-0.56；=0.009）。
结论
NutriCatt 方案改善了老年患者的临床结局，应在 ERAS 结直肠手术中推荐使用。
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