| Research Background and Purpose Malignant obstructive jaundice(MOJ)refers to biliary obstruction caused by malignant tumors of the biliary tract and pancreas.Malignant obstructive jaundice patients often suffer from malnutrition in varying degrees due to cholestasis,impaired digestive function and long term tumor consumption before operation.Its existence often has adverse effects on prognosis and prolongs the length of hospitalization.Therefore,early detection and treatment of malnutrition and weak constitution of patients is helpful to recovery.Studies have shown that proper nutritional support for patients at risk of nutrition can improve their clinical outcomes.On the contrary,nutritional support for patients without significant malnutrition can not only reduce mortality,but also waste medical resources.Therefore,it is essential to use accurate nutritional assessment tools to assess the nutritional status of patients.The Nutritional Risk Assessment Form(NRS-2002)is an inpatient nutrition risk screening method recommended by the European Society of Parenteral and Enteral Nutrition(ESPEN).It is mainly used to assess the nutritional risk of patients within 48 hours of admission.The main purpose is to assess the nutritional risk of patients within 48 hours of admission.Identifying patients who may benefit from nutritional interventions is currently the first choice for preoperative nutritional screening tools.The Mini Nutrition Assessment Method(MNA-SF)is a nutritional status assessment tool designed for elderly patients.It is practical、simplify,and accurate.It is considered to be suitable for routine use in clinical practice.Are the two methods suitable for the nutrition of patients with malignant obstructive jaundice,The assessment of the situation is for further study.Through accurate nutritional assessment tools,patients with nutrition were screened out,and appropriate nutritional support treatment was needed.Parenteral nutrition is the main nutritional support program after operation,which can significantly improve the prognosis of patients,but long-term application of this program will result in a series of complications,such as catheter infection,metabolic disorders,intestinal mucosal damage and atrophy.Studies have shown that early enteral nutrition not only protects the structure and function of intestinal mucosa,but also minimizes the risk of bacterial translocation and systemic inflammation.However,patients with malignant obstructive jaundice have different degrees of digestive dysfunction due to long-term cholestasis in the early stage,so total enteral nutrition may lead to nutritional deficiency.It has been reported that parenteral nutrition combined with enteral nutrition can not only maintain the intestinal barrier function,but also achieve the target feeding volume quickly,meet the metabolic needs of the body and improve the clinical outcomes.At the same time,fish oil fatty emulsion has been proved to have the effects of regulating immune function,inhibiting tumor growth,inhibiting excessive inflammation and various infectious complications.It has been widely used in clinic,especially in perioperative parenteral nutrition support treatment.Therefore,parenteral nutrition supplemented with fish oil fat emulsion may be beneficial to the recovery of the overall function of patients with malignant obstructive jaundice after operation.The objective of this study was to test the effectiveness of the Nutrition Risk Assessment Scale(NRS-2002)and the Mini-Nutrition Assessment Form(MNA-SF)in elderly patients with malignant obstructive jaundice,to assess the incidence of malnutrition and risk,and to compare the results with the traditional nutritional indicators,and to analyze the influencing factors of nutritional status of patients.To explore the effect of fish oil fat emulsion in the treatment of malignant obstructive jaundice,patients with malnutrition were treated with parenteral nutrition combined with enteral nutrition after operation.Methods 108 elderly patients with malignant obstructive jaundice were evaluated by MNA-SF and NRS-2002 within 24 hours after admission.The evaluation results of the two methods were compared and compared with traditional nutritional indicators,and the factors affecting the nutritional status of patients were analyzed.Patients with malnutrition were screened out.In this group of patients,patients undergoing percutaneous transhepatic biliary drainage(PTCD)combined with biliary stent implantation were treated with parenteral combined enteral nutrition support.At the same time,it was divided into fish oil group and control group,and the liver function,inflammation index and complications of the two groups were compared.Data analysis was performed using statistical software SPSS21.0.The measurement data was expressed by(±S).The t test was used for comparison between the two groups.The count data was expressed by rate(%).The comparison between groups was performed by 2 test or continuous correction 2 test.The screening method consistency test was performed using the Kappa test and the Pearson correlation analysis was performed on the indicators.Results 1.A total of 108 patients,65 males and 43 females,aged 65-85 years,with an average age of 72.0 + 11.9 years,were included in the study.The completion rate of the two nutrition assessment tools was 100% and could be completed within 5-10 minutes.A total of 86 people had different degrees of anorexia.According to NRS-2002,94 patients(87%)were at risk of malnutrition;according to MNA-SF,98 patients(91%)were at risk of malnutrition,of which 44(41%)were at risk of malnutrition and 54(50%)were at risk of malnutrition.2.Cross-analysis of the evaluation results of the two methods,kappa consistency test results showed that K = 0.813,P = 0.000,test consistency rate = 104/108 = 96.3%.The results of the two methods were significantly correlated with the traditional nutritional indicators BMI,upper arm circumference(AMC),lower leg circumference(CC),triceps muscle skin fold thickness(TSF),albumin,prealbumin and hemoglobin.Malnutrition,nutritional risk and normal nutrition were related to disease duration,biliary tract infection and cholangitis,but there was no significant correlation with gender and degree of jaundice.3.BMI analysis of patients showed that only a few patients with malnutrition and risk had BMI lower than 18.5 kg/hm,most of them had BMI in normal range.In addition,a considerable number of patients with malnutrition and risk were overweight or obese.At the same time,the albumin,prealbumin and hemoglobin values of more than half of the patients with malnutrition and risk were in the normal range.4.According to NRS-2002,94 patients(87%)were at risk of malnutrition.Among them,82 patients with advanced malignant obstructive jaundice underwent PTCD + biliary stent implantation.All patients underwent combined parenteral and enteral nutrition support.They were divided into fish oil group(42 cases)and control group(40 cases).The levels of albumin and prealbumin in both groups increased gradually after operation.Total bilirubin(TBIL),direct bilirubin(DBIL)and white blood cell count(WBC)in the fish oil group were significantly lower than those in the control group one week after operation.The incidence of biliary tract infection in the control group was significantly higher than that in the fish oil group.Conclusion (1)Malnutrition is widespread in elderly patients with malignant obstructive jaundice.Nutrition assessment should be a part of routine clinical assessment.Both MNA-SF and NRS-2002 can be used to evaluate the nutritional status of these patients with high accuracy.The time of illness,biliary tract infection and cholangitis are all important factors affecting the nutritional status of patients.Individually using traditional nutritional indicators to assess the nutritional status of patients,there will be a considerable number of patients with malnutrition and risk can not be found.(2)Parenteral nutrition combined with enteral nutrition support is an effective scheme for early nutritional support in patients with malignant obstructive jaundice after jaundice reduction.Among them,parenteral nutrition supplementation with fish oil fat emulsion has significant effect in improving cholestasis symptoms,reducing inflammation after operation,and reducing the occurrence of biliary tract infection.It has certain clinical application value. |
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