腹部肌群训练结合营养干预预防老年结直肠癌患者术后肌少症的效果^*

The effect of abdominal muscle training combined with nutritional intervention in preventing postoperative sarcopenia in elderly patients with colorectal cancer

摘要

目的 探讨腹部肌群训练联合营养干预对预防老年结直肠癌患者术后肌少症的有效性及对患者康复的影响。方法 选取2023年1月—10月江苏省肿瘤医院住院并接受择期结直肠癌根治性手术治疗的90例老年患者作为研究对象, 采用随机数字表法将其随机分为研究组和对照组, 各45例。对照组接受常规合理营养干预, 研究组在对照组基础上增加腹部肌群训练。分别于术前及术后3个月评估两组的肌少症发生率、骨骼肌质量指数 (SMI)、握力、4米步速、简易体能状况量表 (SPPB) 评分、术后并发症、住院时间及生活质量。结果 术后3个月, 研究组肌少症发生率低于对照组 (P<0.05), 研究组的SMI、握力、4米步速和SPPB评分均高于对照组 (P<0.05), 术后住院时间短于对照组 (P<0.05)。术后切口感染、肺部感染、尿路感染、肠梗阻的发生率和总体并发症发生率均低于对照组, 但差异无统计学意义 (P>0.05)。研究组总体生活质量评分及各功能领域评分均高于对照组, 症状领域评分均低于对照组, 差异均有统计学意义 (P<0.05)。结论 腹部肌群训练结合营养干预能有效预防老年结直肠癌术后肌少症发生, 改善肌肉水平, 缩短住院时间, 提升生活质量, 具有临床应用价值。

Abstract

Objective To explore the effectiveness of abdominal muscle training combined with nutritional intervention in preventing postoperative sarcopenia in elderly patients with colorectal cancer and its impact on patient recovery. Methods A total of 90 elderly postoperative patients with colorectal cancer from January to October 2023 were selected as a research subject, and they were randomly divided into a study group and a control group (45 cases in each group). The control group received routine and reasonable nutritional intervention, while the study group received additional abdominal muscle training on the basis of the control group. The incidence of sarcopenia, skeletal muscle mass index (SMI), hand grip strength, 4-meter pace, short-physical performance battery score (SPPB), incidence of postoperative complications, length of hospital stay, and quality of life were compared between the two groups before and 3 months after surgery. Results At 3 months after operation, the incidence rate of sarcopenia in study group was lower than that in control group (P<0.05). The SMI, grip strength, 4-meter step speed and SPPB score in study group were higher than those in control group (P<0.05). The postoperative hospital stay was shorter than that in control group (P<0.05). The incidence rate of postoperative incision infection, pulmonary infection, urinary tract infection, intestinal obstruction and overall complication rate in control group were lower than that in control group, but the differences had no statistical significance (P>0.05). The overall quality of life score and each functional domain score in the study group were higher than those in the control group, and the symptom domain score was lower than that in the control group, and the differences were statistically significant (P<0.05). Conclusion Abdominal muscle training combined with nutritional intervention can effectively prevent sarcopenia after colorectal cancer surgery in the elderly, improve muscle levels, shorten hospital stays, and improve quality of life, which has clinical application value.

关键词

结直肠癌 / 腹部肌群训练 / 营养干预 / 肌少症

Key words

Colorectal cancer / Abdominal muscle training / Nutritional intervention / Sarcopenia

参考文献

[1] Roshandel G, Ghasemi—Kebria F, Malekzadeh R. Colorectal cancer: epidemiology, risk factors, and prevention [J]. Cancers (Basel), 2024, 16(8): 1530.

[2] Lin W L, Nguyen T H, Huang W T, et al. Sarcopenia and survival in colorectal cancer without distant metastasis: a systematic review and meta—analysis[J]. J Gastroenterol Hepatol, 2024, 39(11): 2250-2259.

[3] He J, Luo W, Huang Y, et al. Sarcopenia as a prognostic indicator in colorectal cancer: an updated meta—analysis[J]. Front Oncol, 2023, 13: 1247341.

[4] Xie H, Wei L, Liu M, et al. Preoperative computed tomography—assessed sarcopenia as a predictor of complications and long—term prognosis in patients with colorectal cancer: a systematic review and meta—analysis[J]. Langenbecks Arch Surg, 2021, 406(6): 1775-1788.

[5] Wang X, Zeng H, Li L, et al. Personalized nutrition intervention improves nutritional status and quality of life of colorectal cancer survivors in the community: a randomized controlled trial [J]. Nutrition, 2022, 103—104: 111835.

[6] Gupta A, Gupta E, Hilsden R, et al. Preoperative malnutrition in patients with colorectal cancer [J]. Can J Surg, 2021, 64(6): E621-E629.

[7] Chen L K, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.e2.

[8] Hanada M, Yamauchi K, Miyazaki S, et al. Short—Physical Performance Battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: a prospective multicenter cohort study [J]. Chron Respir Dis, 2020, 17: 1479973120961846.

[9] Bergman B, Aaronson N K, Ahmedzai S, et al. The EORTC QLQ—LC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ—C30) for use in lung cancer clinical trials. EORTC study group on quality of life[J]. Eur J Cancer, 1994, 30A(5): 635-642.

[10] Monti E, Tagliaferri S, Zampieri S, et al. Effects of a 2—year exercise training on neuromuscular system health in older individuals with low muscle function[J]. J Cachexia Sarcopenia Muscle, 2023, 14(2): 794-804.

[11] Prokopidis K, Isanejad M, Akpan A, et al. Exercise and nutritional interventions on sarcopenia and frailty in heart failure: a narrative review of systematic reviews and meta—analyses[J]. ESC Heart Fail, 2022, 9(5): 2787-2799.

[12] Zhang J H, Zhu Z, Niu Y J, et al. Exercise combined with vitamin D supplementation has additive health effects on SPPB and stair climbing in older adults: a scope review of randomized controlled trials [J]. Br J Nutr, 2025, 133(1): 48-57.

[13] Liu C, Xu H, Chen L, et al. Exercise and nutritional intervention for physical function of the prefrail: a systematic review and meta—analysis[J]. J Am Med Dir Assoc, 2022, 23(8): 1431.e1-1431.e19.

[14] Furon Y, Dang Van S, Blanchard S, et al. Effects of high—intensity inspiratory muscle training on systemic inflammatory response in cardiac surgery—A randomized clinical trial[J]. Physiother Theory Pract, 2024, 40(4): 778-788.

[15] Zong J, You M, Li C. Effect of Kegel pelvic floor muscle exercise combined with clean intermittent self—catheterization on urinary retention after radical hysterectomy for cervical cancer [J]. Pak J Med Sci, 2022, 38(3Part—I): 462.

[16] Grajek M, Krupa—Kotara K, Białek—Dratwa A, et al. Nutrition and mental health: a review of current knowledge about the impact of diet on mental health[J]. Front Nutr, 2022, 9: 943998.

[17] Toly V B, Zauszniewski J A, Wang M, et al. Efficacy of a resourcefulness intervention to enhance the physical and mental health of parents caring for technology—dependent children at home: a randomized controlled trial[J]. J Pediatr Health Care, 2024, 38(3): 337-353.

基金资助

^*国家自然科学基金项目(82072704)

江苏省肿瘤医院科技发展基金项目(ZH202304)