本文關(guān)鍵詞： 胃癌患者 患者主觀整體評(píng)估 NRS2002 營(yíng)養(yǎng)不良 營(yíng)養(yǎng)支持治療　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:運(yùn)用患者主觀整體評(píng)估(patient-generated subjective global assessment,PG-SGA)方法對(duì)邢臺(tái)市人民醫(yī)院住院的胃癌患者進(jìn)行營(yíng)養(yǎng)現(xiàn)狀及營(yíng)養(yǎng)支持治療進(jìn)行調(diào)查,了解邢臺(tái)市人民醫(yī)院胃癌患者營(yíng)養(yǎng)現(xiàn)狀及營(yíng)養(yǎng)支持治療情況。方法:1本研究隨機(jī)選取調(diào)查2013年6月至2014年12月邢臺(tái)市人民醫(yī)院腫瘤內(nèi)科病理診斷確診胃癌并接受化療一個(gè)月的胃癌患者,并且對(duì)符合納入標(biāo)準(zhǔn)的患者進(jìn)行營(yíng)養(yǎng)現(xiàn)狀及營(yíng)養(yǎng)支持治療調(diào)查。用PG-SGA作為營(yíng)養(yǎng)現(xiàn)狀評(píng)估工具,具體內(nèi)容包括胃癌患者體重指數(shù)、攝食情況、癥狀、活動(dòng)和身體功能、疾病與營(yíng)養(yǎng)需求的關(guān)系、代謝方面的需要、體格檢查等7個(gè)方面評(píng)估營(yíng)養(yǎng)狀況。2數(shù)據(jù)的收集與分析方法數(shù)據(jù)的描述與分析使用SPSS13.0。搜集到的臨床數(shù)據(jù)采用統(tǒng)計(jì)描述,首先對(duì)各實(shí)驗(yàn)組進(jìn)行正態(tài)性與方差齊性檢驗(yàn),如果獨(dú)立樣本的數(shù)據(jù)服從正態(tài)性與方差齊性,計(jì)量資料以(?x±s)表示,采用t檢驗(yàn);相關(guān)性如果數(shù)據(jù)符合雙變量正態(tài)性,采用Pearson線性相關(guān)分析,如不滿足應(yīng)用條件則采用Spearman秩相關(guān)進(jìn)行相關(guān)分析。三個(gè)或三個(gè)以上獨(dú)立樣本的比較采用完全獨(dú)立多樣本比較的單因素方差分析,方差分析有差異,如進(jìn)一步的兩兩比較,采用LSD法進(jìn)行。如果資料不滿足正態(tài)性與方差齊性,則采用多個(gè)獨(dú)立樣本比較Kruskal-Wallis H非參數(shù)檢驗(yàn),進(jìn)一步的兩兩比較采用秩轉(zhuǎn)換的方差分析。檢驗(yàn)水準(zhǔn)設(shè)定為α=0.05,以P0.05認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1本研究共納入99例胃癌患者,其中男性73例(73.73%),女性26例(26.37%);營(yíng)養(yǎng)良好者5例(5.06%),輕度/中度營(yíng)養(yǎng)不良54例(54.54%),重度營(yíng)養(yǎng)不良40例(40.40%);有營(yíng)養(yǎng)支持43例(43.43%),無(wú)營(yíng)養(yǎng)支持56例(56.57%)。腸內(nèi)營(yíng)養(yǎng)聯(lián)合腸外營(yíng)養(yǎng)支持9例(9.09%),單純腸內(nèi)營(yíng)養(yǎng)支持17例(17.17%),單純腸外營(yíng)養(yǎng)支持17例(17.17%)。2營(yíng)養(yǎng)良好患者與輕度/中度營(yíng)養(yǎng)不良及重度營(yíng)養(yǎng)不良患者年齡分布均有所不同,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);重度營(yíng)養(yǎng)不良患者與輕度/中度營(yíng)養(yǎng)不良及營(yíng)養(yǎng)良好患者BMI值均有所不同,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3 PG-SGA總評(píng)分(病人)與PG-SGA(醫(yī)務(wù)人員)定量評(píng)價(jià)的相關(guān)性研究表明營(yíng)養(yǎng)狀況良好患者、輕中度營(yíng)養(yǎng)不良患者及重度營(yíng)養(yǎng)不良患者其相關(guān)性分別為0.97、0.90、0.96,P值均為0.00,相關(guān)性顯著并且具有統(tǒng)計(jì)學(xué)意義(P0.05)。NRS2002評(píng)分同住院總時(shí)間有相關(guān)性,相關(guān)系數(shù)為0.22,具有統(tǒng)計(jì)學(xué)意義(P0.05)。4各組患者住院費(fèi)用分析,營(yíng)養(yǎng)良好患者平均住院花費(fèi)12148元、輕度/中度營(yíng)養(yǎng)不良患者平均住院花費(fèi)20293元、重度營(yíng)養(yǎng)不良患者平均住院花費(fèi)24189元,營(yíng)養(yǎng)良好患者與重度營(yíng)養(yǎng)不良患者住院花費(fèi)有所不同,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5營(yíng)養(yǎng)治療患者BMI指數(shù)分析,腸內(nèi)外聯(lián)合治療患者與單純腸內(nèi)營(yíng)養(yǎng)治療患者及單純腸外營(yíng)養(yǎng)治療患者BMI指數(shù)總體分布相同,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。營(yíng)養(yǎng)治療患者住院費(fèi)用分析,腸內(nèi)外聯(lián)合治療患者平均住院花費(fèi)45933元、單純腸內(nèi)營(yíng)養(yǎng)治療患者平均住院花費(fèi)8012元、單純腸外營(yíng)養(yǎng)治療患者平均住院花費(fèi)38603元,單純腸內(nèi)營(yíng)養(yǎng)治療患者住院費(fèi)用與腸內(nèi)外聯(lián)合治療患者及單純腸外營(yíng)養(yǎng)治療患者住院花費(fèi)均有所不同,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。6營(yíng)養(yǎng)治療患者血清生化指標(biāo)分析,血清白蛋白水平(36.27±4.66)g/L、總蛋白水平61.04±9.34 g/L;未經(jīng)營(yíng)養(yǎng)治療后患者血清白蛋白38.71±5.92 g/L、總蛋白水平66.82±8.08 g/L;以上兩項(xiàng)結(jié)果均存在差異,有統(tǒng)計(jì)學(xué)意義(P0.05)。7營(yíng)養(yǎng)治療患者BMI指數(shù)為(19.52±3.06)kg/m2,三頭肌皮褶厚度(TSF)為7.20±3.70mm,上臂肌肉周徑(MAMC)為18.44±6.89 cm;未經(jīng)營(yíng)養(yǎng)治療患者BMI指數(shù)為21.72±3.44 kg/m2,三頭肌皮褶厚度(TSF)為9.52±5.41mm,上臂肌肉周徑(MAMC)為21.18±4.61cm,以上三項(xiàng)結(jié)果均存在差異,有統(tǒng)計(jì)學(xué)意義(P0.05)。8營(yíng)養(yǎng)治療和未經(jīng)營(yíng)養(yǎng)治療患者年齡分布結(jié)果為(63.56±10.25)歲和62.81±10.41歲,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。營(yíng)養(yǎng)治療患者卡氏評(píng)分和NRS2002定量結(jié)果分別為68.60±15.21、57.00±11.34,未經(jīng)營(yíng)養(yǎng)治療患者卡氏評(píng)分和NRS2002定量結(jié)果分別為84.07±10.37、52.39±8.29,以上兩項(xiàng)結(jié)果差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:住院胃癌患者營(yíng)養(yǎng)不良發(fā)生率較高,重度營(yíng)養(yǎng)不良患者BMI水平降低明顯、住院花費(fèi)較高;住院胃癌患者腸內(nèi)外聯(lián)合營(yíng)養(yǎng)支持治療的使用率低;納入營(yíng)養(yǎng)支持治療的患者自身處于惡病質(zhì)狀態(tài),一方面食欲不振,另一方面即使補(bǔ)充營(yíng)養(yǎng)效果也不顯著,患者血清白蛋白水平、總蛋白水平、BMI指數(shù)、三頭肌皮褶厚度(TSF)和上臂肌肉周徑均較未經(jīng)營(yíng)養(yǎng)治療患者有所降低。體質(zhì)指標(biāo)處于未接受營(yíng)養(yǎng)治療患者95%可信區(qū)間臨界值以?xún)?nèi)無(wú)論自身感覺(jué)營(yíng)養(yǎng)狀況良好與否,都建議給予臨床營(yíng)養(yǎng)支持。鑒于上述指標(biāo)對(duì)機(jī)體恢復(fù)相對(duì)敏感,可以作為今后營(yíng)養(yǎng)支持成功與否的臨床觀察指標(biāo)。
[Abstract]:Objective: Patients with subjective global assessment (patient-generated subjective global assessment, PG-SGA) method of nutritional status and nutritional support treatment were investigated in patients with gastric cancer admitted to Xingtai People's Hospital, Xingtai People's Hospital patients understand the nutritional status and nutritional support for the treatment of gastric cancer. Methods: This study randomly selected 1 surveys from June 2013 to December 2014 in Xingtai People's Hospital oncology and pathological diagnosis of gastric cancer a month of chemotherapy in patients with gastric cancer, and the patients who met the inclusion criteria of nutrition status and nutritional support treatment camp investigation. Using PG-SGA as a nutritional status assessment tool, including body mass index, gastric cancer patients with feeding, symptoms, activities and physical function, relationship between disease and nutritional needs, need metabolism. 7 aspects of physical examination to assess the nutritional status of.2 data collection The clinical data collection and analysis methods of description and analysis of data collected using SPSS13.0. first described by statistics, normality and homogeneity of variance test in the experimental group, if independent sample data obey normality and homogeneity of variance, measurement data with (? X + s) expressed by t test if the data are consistent with bivariate correlation; normality, using Pearson linear correlation analysis, such as do not meet the application conditions by Spearman rank correlation analysis. Three or more than three independent samples compared with completely independent samples were compared using one-way ANOVA, analysis of variance is different, such as further 22. Using the method of LSD. If the data does not satisfy the normality and homogeneity of variance, using multiple independent samples Kruskal-Wallis H nonparametric test, a further 22 compared with the rank transformation test analysis of variance. The alpha level is set to =0.05, to P0.05 that the difference was statistically significant. Results: 1 this study included 99 cases of gastric cancer patients, including 73 cases of male (73.73%), 26 cases were female (26.37%); 5 cases of good nutrition (5.06%), mild / moderate malnutrition in 54 cases (54.54%), weight of nutrition poor in 40 cases (40.40%); nutrition support in 43 cases (43.43%), no nutritional support for 56 cases (56.57%). Enteral nutrition combined with parenteral nutrition in 9 cases (9.09%), simple enteral nutrition in 17 cases (17.17%), 17 cases of simple parenteral nutritional support (17.17%).2 good nutrition patients with mild / moderate malnutrition and severe malnutrition in patients with age distribution are different, the difference was statistically significant (P0.05); severe malnutrition in patients with mild / moderate malnutrition and good nutrition in patients with BMI values are different, the difference was statistically significant (P0.05).3 PG-SGA total score (patients) and PG-SGA (medical personnel Study on the correlation between quantitative evaluation showed) good nutritional status in patients with mild to moderate malnutrition and severe malnutrition in patients and the correlation were 0.97,0.90,0.96, P value was 0, and significantly correlated with statistical significance (P0.05).NRS2002 score has significant correlation with the total hospitalization time, the correlation coefficient was 0.22, with statistical significance (P0.05) analysis the hospitalization expenses of patients in each group were.4, good nutrition and the average hospitalization cost of 12148 yuan, mild / moderate malnutrition in patients with the average hospitalization cost of 20293 yuan, the severe malnutrition patients average hospitalization cost 24189 yuan, good nutrition in patients with severe malnutrition patients hospitalized cost is different, the difference was statistically significant (P0.05) analysis of.5 nutrition in the treatment of patients with BMI index treatment of patients with combined enteral and parenteral and enteral nutrition in the treatment of patients with pure and simple parenteral nutrition in the treatment of patients with BMI index overall points The same cloth, there was no statistically significant difference (P0.05). Analysis of hospitalization expenses for nutrition therapy with combined enteral and parenteral treatment of patients with the average hospitalization cost of 45933 yuan, with enteral nutrition in the treatment of patients with the average hospitalization cost of 8012 yuan, only parenteral nutrition in the treatment of patients with the average hospitalization cost of 38603 yuan, with enteral nutrition in the treatment of patients with hospitalization and parenteral combined treatment of patients and the cost are different in simple intestinal nutrition treatment of patients, the difference was statistically significant (P0.05) analysis of.6 nutrition treatment in patients with serum biochemical indexes, serum albumin level (36.27 + 4.66) g/L, total protein level of 61.04 + 9.34 g/L; without nutrition after treatment of patients with serum albumin 38.71 + 5.92 g/L, total the protein level of 66.82 + 8.08 g/L; there were differences in the above two results, with statistical significance (P0.05).7 nutrition on patients with BMI index (19.52 + 3.06) kg/m2, triceps skinfold thickness (T SF) 7.20 + 3.70mm, upper arm muscle circumference (MAMC) was 18.44 + 6.89 cm; without nutrition treatment BMI index of patients was 21.72 + 3.44 kg/m2, triceps skinfold thickness (TSF) was 9.52 + 5.41mm, upper arm muscle circumference (MAMC) was 21.18 + 4.61cm, there are differences in the above three results there was statistical significance (P0.05),.8 nutrition therapy and nutrition therapy without the age distribution of patients was (63.56 + 10.25) years and 62.81 + 10.41 years, there was no statistically significant difference (P0.05). The nutritional therapy in patients with Karnofsky score and NRS2002 quantitative results were 68.60 + 15.21,57.00 + 11.34, without nutritional therapy in patients with card NRS2002's scores and the quantitative results were 84.07 + 10.37,52.39 + 8.29, more than two showed statistically significant differences (P0.05). Conclusion: the hospitalization of patients with gastric cancer incidence rate of malnutrition was higher in patients with severe malnutrition, BMI levels decreased significantly, hospitalization costs are higher in gastric cancer; Patients with combined enteral and parenteral nutritional support therapy use rate is low; included in the nutrition support therapy itself in cachexia, a loss of appetite, on the other hand even if the nutrition effect is not significant, the level of serum albumin in patients, the total protein level, BMI index, triceps skinfold thickness (TSF) and arm muscle circumference is not after treatment, patients with nutrition decreased. Body mass index in patients with nutritional therapy did not receive a 95% confidence interval of critical value within both feel good nutrition or not, are recommended for clinical nutritional support. In view of the above indicators are relatively sensitive to body recovery, can be used as a clinical index for nutritional support future success.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R735.2;R459.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 于健春;;腸內(nèi)營(yíng)養(yǎng)的理念及治療規(guī)范[J];臨床藥物治療雜志;2009年06期

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本文編號(hào)：1522212