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目的:了解营养支持对有营养风险胃肠恶性肿瘤病人有无改善临床结局和成本-效果比的影响。方法:2014年12月至2015年8月,以连续抽样方式对胃肠道恶性肿瘤病人营养风险发生率、临床结局和医疗费用进行资料收集。结果:共纳入244例病人,在有营养风险者中,营养支持组总并发症率(31.94%vs 57.89%,P=0.04)以及非感染性并发症的发生率(25.00%vs 52.63%,P=0.02)显著低于无营养支持组。另外,肠内营养组在非感染性并发症风险的减少方面有绝对优势(16.67%vs 52.63%,P=0.03)。多因素分析确认营养支持改善病人总并发症发生率的结论稳定(OR=0.62,95%CI=0.37~0.81,P<0.01)。存在营养风险且接受营养支持病人的总费用比未接受营养支持者高,两组成本-效果比分别为8 175.9和7 184.9,增量成本-效果比为3 819.2。结论:对胃肠恶性肿瘤有营养风险的病人给予营养支持,可减少并发症的发生率和缩短住院时间,其成本-效果比水平高。
OBJECTIVES: To understand the effect of nutritional support on the clinical outcome and cost-benefit ratio of patients with gastrointestinal malignancies at nutritional risk. Methods: From December 2014 to August 2015, the incidence of nutritional risk, clinical outcome and medical expenses of patients with gastrointestinal cancer were collected by continuous sampling. Results: A total of 244 patients were enrolled in this study. The total complication rates of nutrition support group (31.94% vs 57.89%, P = 0.04) and noninfectious complications (25.00% vs 52.63%, P = 0.02) was significantly lower than the group without nutritional support. In addition, the enteral nutrition group had an absolute advantage in reducing the risk of noninfectious complications (16.67% vs 52.63%, P = 0.03). Multivariate analysis confirmed that nutritional support improved the overall complication rate of patients (OR = 0.62, 95% CI = 0.37-0.81, P <0.01). The total cost of nutritional risk and nutritional support patients was higher than those who did not receive nutritional support. The cost-effectiveness ratios were 8 175.9 and 7 184.9, respectively, and the incremental cost-effectiveness ratio was 3 819.2. CONCLUSION: Nutritional support for patients at risk of having gastrointestinal malignancies reduces the incidence of complications and hospital stays, with a higher cost-effectiveness ratio.