Clinical value of preoperative nutritional support therapy in the hepatectomy of patients with nutritional risk: a prospective study

Abstract

Objective To investigate the clinical value of preoperative nutritional support (PNS) therapy in the hepatectomy of patients with nutritional risk. Methods The prospective study was conducted. The clinical data of 133 patients with nutritional risk who were admitted to the Drum Tower Hospital Affiliated to Nanjing University Medical School from August 2012 to June 2016 were collected. All the patients undergoing PNS and traditional therapy were divided into the PNS group and the control group by random number table method, respectively. Observation indicators: (1) comparisons of laboratory indexes between groups; (2) comparisons of postoperative situations between groups; (3) comparisons of postoperative complications between groups. Measurement data with normal distribution were represented as ±s. Comparisons between groups were evaluated with the independent-sample t test. Comparisons of count data were analyzed using the chi-square test, and repeated measures data were analyzed by the repeated measures ANOVA. Results All the 133 patients were screened for eligibility, including 68 in the PNS group and 65 in the control group. (1) Comparisons of laboratory indexes between groups: alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil), cholinesterase, albumin (Alb), prealbumin, transferrin and C-reactive protein (CRP) in the PNS group were respectively (36±13)U/L, (29±10)U/L, (18.5±2.4)mmol/L, (5 738±1 824)U/L, (37.4±5.1)g/L, (155±48)mg/L, (2.2±0.5)g/L, (10±4)g/L at admission and (33±9)U/L, (27±8)U/L, (17.9±1.8)mmol/L, (5 796±2 016)U/L, (38.5±4.7)g/L, (181±40)mg/L, (2.4±0.5)g/L, (8±4)g/L before operation and (285±100)U/L, (218±93)U/L, (33.5±6.3)mmol/L, (4 847±1 044)U/L, (32.6±3.8)g/L, (105±34)mg/L, (1.3±0.4)g/L, (55±28)g/L at 1 day postoperatively and (149±84)U/L, (76±42)U/L, (22.7±4.9)mmol/L, (3 866±893)U/L, (34.2±2.4)g/L, (125±30)mg/L, (1.6±0.4)g/L, (51±34)g/L at 3 days postoperatively and (64±33)U/L, (44±18)U/L, (19.4±2.8)mmol/L, (4 257±1 032)U/L, (37.0±2.1)g/L, (148±42)mg/L, (1.9±0.4)g/L, (16±11)g/L at 7 days postoperatively; ALT, AST, TBil, cholinesterase, Alb, prealbumin, transferrin and CRP in the control group were respectively (36±15)U/L, (31±12)U/L, (18.3±2.9)mmol/L, (5 762±1 693)U/L, (37.3±6.1)g/L, (162±51)mg/L, (2.3±0.5)g/L, (10±4)g/L at admission and (36±11)U/L, (30±11)U/L, (18.2±2.8)mmol/L, (5 789±1 673)U/L, (37.8±7.1)g/L, (166±57)mg/L, (2.3±0.6)g/L, (9±5)g/L before operation and (305±127)U/L, (246±104)U/L, (34.2±7.8)mmol/L, (4 842±1 173)U/L, (32.0±4.1)g/L, (83±32)mg/L, (1.2±0.4)g/L, (61±31)g/L at 1 day postoperatively and (163±104)U/L, (82±62)U/L, (23.1±6.0)mmol/L, (3 672±937)U/L, (33.8±3.6)g/L, (106±30)mg/L, (1.4±0.4)g/L, (61±40)g/L at 3 days postoperatively and (77±48)U/L, (52±27)U/L, (20.2±3.5)mmol/L, (3 925±987)U/L, (36.6±2.8)g/L, (125±40)mg/L, (1.7±0.4)g/L, (22±12)g/L at 7 days postoperatively, showing no statistically significant difference in changing trends of above indicators between groups (F=1.007, 2.223, 0.579, 0.014, 0.235, 3.533, 2.970, 2.143, P>0.05). Results of further analysis showed that there were statistically significant differences in the levels of ALT, AST and cholinesterase at 7 days postoperatively between groups (t=1.832, 2.073, 1.899, P<0.05), and in the levels of prealbumin before operation and at 1, 3 and 7 days postoperatively between groups (t=1.698, 3.738, 3.625, 3.178, P<0.05) and in the levels of transferrin and CRP at 3 and 7 days postoperatively between groups (t=2.917, 2.709, 1.667, 2.990, P<0.05). (2) Comparisons of postoperative situations between groups: time to initial exsufflation, time of initial defecation, infused volume of exogenous albumin and duration of postoperative hospital stay were respectively (46±15)hours, (64±16)hours, (23±10)g, (9.2±2.6)days in the PNS group and (55±18)hours, (78±21)hours, (39±25)g, (11.7±5.3)days, with statistically significant differences in the above indicators between groups (t=2.830, 4.157, 5.044, 3.497, P<0.05). (3) Comparisons of postoperative complications between groups: 23 and 33 patients in the PNS and control groups had postoperative complications, showing a statistically significant difference between groups (χ2=3.915, P<0.05). Eight and 17 patients in the PNS and control groups were respectively complicated with peritoneal effusion, with a statistically significant difference between groups (χ2=4.508, P<0.05). Conclusion PNS therapy in the hepatectomy of patients with nutrition risk can effectively improve pre- and post-operative nutrition statuses, reduce liver damage, accelerate recoveries of liver and gastrointestinal functions, reduce complications, shorten duration of postoperative hospital stay and accelerate patients′ recovery. Key words: Liver diseases; Hepatectomy; Nutrition risk; Nutritional support therapy; Enhanced recovery after surgery