Clinical Study Of Nutritional Risk Screening And Nutritional Support In Oral Cancer

Objetive: the objective of this research was to(1)assess the incidence of nutritional risk in patients with oral cancer;(2)explore the effect of radical operation on nutritional status of patients with oral cancer;(3)investigate the effect of different nutritional support on postoperative patients with oral cancer.Methods: Choose the patients with oral cancer(including gingival carcinoma,squamous cell carcinoma of the tongue,buccal carcinoma,carcinoma of the floor of mouth)hospitaled in hospital of oral and maxillofacial surgery of the First Affiliated Hospital of Southwest University of Medical Sciences from September 1,2014 to October 31,2016.All patients were treated with NRS 2002(Nutrition Risk Screening 2002)for nutritional risk screening after admission.The basic data of patients were recorded: name,sex,age,height,weight,tumor type and stage;Laboratory test records: albumin(ALB),hemoglobin(HGB),lymphocyte count(LYM),lymphocyte rate(LYM-R);Body measurement: Triceps skinfold thickness(TSF),Mid arm circumference(AMC),Body mass index(BMI).Analyze the incidence of nutritional risk of oral cancer;Explore the relationship between the clinical stage,growth zone of oral cancer and the risk of nutritional risk;and explore the relationship between age and nutritional risk in patients with oral cancer.Surgical treatment was operated on the oral cancer patients who met the suigical indications and agreed with the radical surgical treatment.The surgical operation included extended resection of oral cancer,free flap transplantation,cervical lymph node dissection.After operation,the patients were sent to the intensive care unit for observation and treatment.The patients were divided into experimental group and control group according to different nutritional support.The patients in the control group received total parenteral nutrition(TPN total parenteral nutrition),and the experimental group received early enteral combined parenteral nutrition support.patients were measured and recorded the laboratory indexes and body measurements at the fourth day,the tenth day after surgical operation and on the hospital discharged.The incidence of complications,length of stay,and duration of drainage were recorded.The nutritional status and clinical effect were compared and evaluated between the experimental group and the control group.Result: Preoperative nutritional risk screening in patients with oral cancer was total in 144 patients,including male 77 cases and female 67 cases.They concluded 56 cases in squamous cell carcinoma of the tongue,floor of mouth cancer in 39 cases,28 cases of gingival carcinoma,21 cases of buccal cancer.And primary tumor in 39 cases,41 cases of stage II,31 cases in stage III,33 cases in stage IV.There were 39 patients with nutritional risk,about 27.1%.The later the clinical stage of oral cancer was,the higher the nutritional risk existed.There was no significant relationship between oral cancer site and nutritional risk.39 cases of nutritional risk in patients with albumin was lower than 35g/L,the body mass index(BMI)of 8 patients was lower than 18.5kg/m2.77 patients were included in the experimental program,including complete parenteral nutrition support group(control group)and early enteral nutrition combined with parenteral nutrition(experimental group)in 40 cases(n = 37).There was no significant difference in albumin,total protein,hemoglobin,C reactive protein,lymphocyte count and lymphocyte percentage between the experimental group and the control group before the operation and at the fourth days after operation(P>0.05).On the tenth day after operation,the C reactive protein in the experimental group was lower than that in the control group,the experimental group was 23.6±6.7,while the control group was 28.8±8.3(P<0.05).The albumin,hemoglobin,lymphocyte count and lymphocyte percentage in the experimental group were higher than those in the control group(P < 0.05).The negative pressure drainage tube indwelling time of the patients was 6.2±1.3 days in the experimental group and the control group was 7.3 ± 1.7 days;The average hospitalization days of the patients were 11.6 ± 2.5 days in the experimental group,and the control group was 13.4 ± 3.1 days.The average length of stay and neck drainage time in the experimental group were lower than those in the control group(P < 0.05).Infectious complications: 6 cases occurred in the experimental group,and 5 cases in the control group.Patients before and after discharge weight difference,the experimental group(2.81±0.46kg)< the control group(3.24±0.58kg),the difference was significant(P < 0.05).Patients with preoperative deltoid skinfold thickness difference: the experimental group(3.72±0.63mm)< the control group(4.15±0.68mm),the difference is obvious(P < 0.05).The difference of the midpoint diameter of the upper arm of the discharged patients between before operation and hospital discharge was: the experimental group(2.94±0.86cm)< the control group(3.62±1.02 cm),the difference is obvious(P < 0.05).The difference of BMI index of patients between before operation and hospital discharge was: the experimental group(0.96±0.43)< the control group(1.21±0.52),the difference was significant(P < 0.05).Conclusion: The incidence of nutritional risk in patients with oral cancer was high,and it was reached about 27.1%,of which there is no significant relationship between tumor location and nutritional risk.The higher the clinical stage of oral cancer was,the higher the incidence of nutritional risk existed.Early enteral nutrition combined with parenteral nutrition support could reduce the number of days of hospitalization and improve the nutritional status of patients without nutritional risk.