發(fā)布時間：2018-02-21 15:20

  本文關鍵詞： 胃癌患者 患者主觀整體評估 NRS2002 營養(yǎng)不良 營養(yǎng)支持治療　出處：《河北醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:運用患者主觀整體評估(patient-generated subjective global assessment,PG-SGA)方法對邢臺市人民醫(yī)院住院的胃癌患者進行營養(yǎng)現(xiàn)狀及營養(yǎng)支持治療進行調(diào)查,了解邢臺市人民醫(yī)院胃癌患者營養(yǎng)現(xiàn)狀及營養(yǎng)支持治療情況。方法:1本研究隨機選取調(diào)查2013年6月至2014年12月邢臺市人民醫(yī)院腫瘤內(nèi)科病理診斷確診胃癌并接受化療一個月的胃癌患者,并且對符合納入標準的患者進行營養(yǎng)現(xiàn)狀及營養(yǎng)支持治療調(diào)查。用PG-SGA作為營養(yǎng)現(xiàn)狀評估工具,具體內(nèi)容包括胃癌患者體重指數(shù)、攝食情況、癥狀、活動和身體功能、疾病與營養(yǎng)需求的關系、代謝方面的需要、體格檢查等7個方面評估營養(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)計描述,首先對各實驗組進行正態(tài)性與方差齊性檢驗,如果獨立樣本的數(shù)據(jù)服從正態(tài)性與方差齊性,計量資料以(?x±s)表示,采用t檢驗;相關性如果數(shù)據(jù)符合雙變量正態(tài)性,采用Pearson線性相關分析,如不滿足應用條件則采用Spearman秩相關進行相關分析。三個或三個以上獨立樣本的比較采用完全獨立多樣本比較的單因素方差分析,方差分析有差異,如進一步的兩兩比較,采用LSD法進行。如果資料不滿足正態(tài)性與方差齊性,則采用多個獨立樣本比較Kruskal-Wallis H非參數(shù)檢驗,進一步的兩兩比較采用秩轉換的方差分析。檢驗水準設定為α=0.05,以P0.05認為差異具有統(tǒng)計學意義。結果: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%);營養(yǎng)良好者5例(5.06%),輕度/中度營養(yǎng)不良54例(54.54%),重度營養(yǎng)不良40例(40.40%);有營養(yǎng)支持43例(43.43%),無營養(yǎng)支持56例(56.57%)。腸內(nèi)營養(yǎng)聯(lián)合腸外營養(yǎng)支持9例(9.09%),單純腸內(nèi)營養(yǎng)支持17例(17.17%),單純腸外營養(yǎng)支持17例(17.17%)。2營養(yǎng)良好患者與輕度/中度營養(yǎng)不良及重度營養(yǎng)不良患者年齡分布均有所不同,差異具有統(tǒng)計學意義(P0.05);重度營養(yǎng)不良患者與輕度/中度營養(yǎng)不良及營養(yǎng)良好患者BMI值均有所不同,差異具有統(tǒng)計學意義(P0.05)。3 PG-SGA總評分(病人)與PG-SGA(醫(yī)務人員)定量評價的相關性研究表明營養(yǎng)狀況良好患者、輕中度營養(yǎng)不良患者及重度營養(yǎng)不良患者其相關性分別為0.97、0.90、0.96,P值均為0.00,相關性顯著并且具有統(tǒng)計學意義(P0.05)。NRS2002評分同住院總時間有相關性,相關系數(shù)為0.22,具有統(tǒng)計學意義(P0.05)。4各組患者住院費用分析,營養(yǎng)良好患者平均住院花費12148元、輕度/中度營養(yǎng)不良患者平均住院花費20293元、重度營養(yǎng)不良患者平均住院花費24189元,營養(yǎng)良好患者與重度營養(yǎng)不良患者住院花費有所不同,差異具有統(tǒng)計學意義(P0.05)。5營養(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)營養(yǎng)治療患者及單純腸外營養(yǎng)治療患者BMI指數(shù)總體分布相同,差異無統(tǒng)計學意義(P0.05)。營養(yǎng)治療患者住院費用分析,腸內(nèi)外聯(lián)合治療患者平均住院花費45933元、單純腸內(nèi)營養(yǎng)治療患者平均住院花費8012元、單純腸外營養(yǎng)治療患者平均住院花費38603元,單純腸內(nèi)營養(yǎng)治療患者住院費用與腸內(nèi)外聯(lián)合治療患者及單純腸外營養(yǎng)治療患者住院花費均有所不同,差異具有統(tǒng)計學意義(P0.05)。6營養(yǎng)治療患者血清生化指標分析,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;以上兩項結果均存在差異,有統(tǒng)計學意義(P0.05)。7營養(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,以上三項結果均存在差異,有統(tǒng)計學意義(P0.05)。8營養(yǎng)治療和未經(jīng)營養(yǎng)治療患者年齡分布結果為(63.56±10.25)歲和62.81±10.41歲,差異無統(tǒng)計學意義(P0.05)。營養(yǎng)治療患者卡氏評分和NRS2002定量結果分別為68.60±15.21、57.00±11.34,未經(jīng)營養(yǎng)治療患者卡氏評分和NRS2002定量結果分別為84.07±10.37、52.39±8.29,以上兩項結果差異均有統(tǒng)計學意義(P0.05)。結論:住院胃癌患者營養(yǎng)不良發(fā)生率較高,重度營養(yǎng)不良患者BMI水平降低明顯、住院花費較高;住院胃癌患者腸內(nèi)外聯(lián)合營養(yǎng)支持治療的使用率低;納入營養(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,另一方面即使補充營養(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)營養(yǎng)治療患者有所降低。體質(zhì)指標處于未接受營養(yǎng)治療患者95%可信區(qū)間臨界值以內(nèi)無論自身感覺營養(yǎng)狀況良好與否,都建議給予臨床營養(yǎng)支持。鑒于上述指標對機體恢復相對敏感,可以作為今后營養(yǎng)支持成功與否的臨床觀察指標。
[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.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.2;R459.3

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本文編號：1522212