本文選題：鼻咽癌　切入點：放療　出處：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]1.明確鼻咽癌患者在放療前、中、后三個時期的營養(yǎng)、飲食攝入量、疼痛程度、放療不良反應及心理狀態(tài)的情況和其相應的變化趨勢。2.分析鼻咽癌放療患者的一般資料、飲食攝入量、疼痛程度、放療不良反應及心理狀態(tài)對其營養(yǎng)狀況的影響,探討放療期間鼻咽癌患者營養(yǎng)狀況的影響因素,為臨床上制定相應的營養(yǎng)干預方案提供科學依據(jù)。[方法]選擇2015年12月～2016年12月在昆明醫(yī)科大學第三附屬醫(yī)院符合條件的鼻咽癌放療患者,采用患者自身前后對照的方法,使用統(tǒng)一的調查表,調查患者的一般資料,主要內容包括:性別、年齡、居住地、家庭人均收入、職業(yè)、婚姻狀況、文化程度、既往病史、吸煙飲酒史、TNM分期、病理類型、化療史、放療方式和劑量。并在放療前、放療第4周及放療后對患者的營養(yǎng)狀況、飲食攝入量、疼痛程度、放療不良反應及心理狀態(tài)進行調查,動態(tài)評估并分析鼻咽癌放療患者的營養(yǎng)狀況及其影響因素。單因素分析采用X2檢驗,多因素分析采用二元Logistic回歸模型,P0.05為有統(tǒng)計學意義。[結果]1.共有44例患者符合納入排除標準,在放療前有11例(25%)患者有營養(yǎng)不良或存在營養(yǎng)風險,重度營養(yǎng)不良患者僅1例(2%),接受放療后,營養(yǎng)不良的患者高達73%,且大部分為重度營養(yǎng)不良(66%)。2.配對t檢驗結果顯示:患者的營養(yǎng)指標,如體質指數(shù)、血清白蛋白、血清前白蛋白、淋巴細胞計數(shù)、血清轉鐵蛋白,在放療后均較放療前下降,差異有統(tǒng)計學意義(P0.001)。3.患者的飲食攝入量、焦慮抑郁評分、疼痛評分及放療不良反應發(fā)生率在放療前后的變化均具有統(tǒng)計學意義(P0.05)。4. x2檢驗結果顯示:同步化療、飲食減少≥1/2、抑郁為放療期間鼻咽癌患者營養(yǎng)狀況的影響因素。Logistic回歸分析顯示:同步化療、飲食減少≥1/2是放療期間鼻咽癌患者營養(yǎng)狀況的獨立影響因素。[結論]1.鼻咽癌患者營養(yǎng)不良的發(fā)生率高,在接受放療后其營養(yǎng)狀況進一步加劇,且在放療期間患者的相關營養(yǎng)指標不斷下降。2.隨著放療次數(shù)和劑量的增加,患者的飲食攝入量明顯減少,焦慮、抑郁、疼痛的評分逐漸增加,發(fā)生放療不良反應的患者增多。3.同步化療、飲食減少≥1/2是放療期間鼻咽癌患者營養(yǎng)狀況的獨立影響因素。4.積極做好鼻咽癌患者放療前、中、后營養(yǎng)狀況的篩查和評估,尤其是需行同步化療及飲食減少≥1/2的患者,以便盡早發(fā)現(xiàn)患者的營養(yǎng)問題并實施有效的營養(yǎng)干預可望改善鼻咽癌患者放療期間的營養(yǎng)狀況,減少營養(yǎng)不良的發(fā)生,提高生活質量,改善預后。
[Abstract]:[objective] 1.To determine the nutritional status, dietary intake, pain degree, adverse reaction and psychological state of nasopharyngeal carcinoma patients before, during and after radiotherapy.To analyze the influence of general data, diet intake, pain degree, adverse reaction of radiotherapy and psychological state on the nutritional status of patients with nasopharyngeal carcinoma (NPC), and to explore the influencing factors of nutritional status of patients with nasopharyngeal carcinoma (NPC) during radiotherapy.To provide scientific basis for clinical formulation of corresponding nutritional intervention program.[methods] patients with nasopharyngeal carcinoma who were eligible for radiotherapy in the third affiliated Hospital of Kunming Medical University from December 2015 to December 2016 were selected.The main contents include: sex, age, residence, family income per capita, occupation, marital status, education level, previous medical history, smoking and drinking history, TNM stage, pathological type, chemotherapy history, radiotherapy method and dose.The nutritional status, dietary intake, pain degree, adverse reaction and psychological state of patients with nasopharyngeal carcinoma were investigated before, 4 weeks and after radiotherapy. The nutritional status and its influencing factors of patients with nasopharyngeal carcinoma (NPC) were evaluated and analyzed dynamically.Single factor analysis using X2 test, multivariate analysis using binary Logistic regression model (P0.05) was statistically significant.[result] 1.A total of 44 patients met the exclusion criteria. Before radiotherapy, 11 patients were malnourished or at risk of nutrition, while only 1 patient with severe malnutrition received radiotherapy.The number of malnourished patients is as high as 73, and most of them are severe malnutrition.The results of paired t test showed that the nutritional indexes, such as body mass index, serum albumin, serum prealbumin, lymphocyte count and serum transferrin, all decreased after radiotherapy compared with those before radiotherapy, and the difference was statistically significant.The changes of dietary intake, anxiety and depression score, pain score and adverse reaction rate of radiotherapy before and after radiotherapy were statistically significant.Diet reduction 鈮，

本文編號：1706123