發(fā)布時間：2018-06-28 10:36

  本文選題：兒童 + 神經(jīng)母細(xì)胞瘤�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評估初診神經(jīng)母細(xì)胞瘤(nueroblastoma,NB)患兒營養(yǎng)狀態(tài),分析營養(yǎng)學(xué)指標(biāo),對合并營養(yǎng)不良患兒進(jìn)行營養(yǎng)治療,并統(tǒng)計其手術(shù)后、化療后并發(fā)癥發(fā)生率及住院時間、費(fèi)用等衛(wèi)生經(jīng)濟(jì)學(xué)指標(biāo),闡明腫瘤患兒營養(yǎng)治療對輔助腫瘤治療的重要性。方法:2014年10月-2016年12月期間根據(jù)STRONGkids營養(yǎng)風(fēng)險篩查評估表,篩選出中風(fēng)險以上的神經(jīng)母細(xì)胞瘤患兒共128例,因22例患兒放棄治療(其中確診NB后放棄有8例,中斷腫瘤治療4例,中斷營養(yǎng)治療有10例),故納入本組資料分析的患兒只有106例,依據(jù)家屬意愿分為營養(yǎng)支持治療組52例,非營養(yǎng)支持治療組54例,評估兩組患兒初診時營養(yǎng)狀況,對營養(yǎng)支持組進(jìn)行規(guī)范持續(xù)的營養(yǎng)治療,分析兩組患兒手術(shù)后并發(fā)癥、第四次化療后并發(fā)癥,營養(yǎng)學(xué)指標(biāo)、平均住院時間、平均住院次數(shù),總住院費(fèi)用、非計劃再次入院率等衛(wèi)生經(jīng)濟(jì)學(xué)指標(biāo)。結(jié)果:(1)膳食調(diào)查:納入分析的106例初診NB患兒中,根據(jù)膳食調(diào)查結(jié)果,提示所有NB患兒能量及蛋白質(zhì)平均攝入量較能量和蛋白質(zhì)的每日推薦攝入量低;(2)各階段營養(yǎng)不良患比率的變化:初診時營養(yǎng)不良60例,占56.6%,兩組相比無顯著性差異(P0.05);腫瘤切除術(shù)后:總營養(yǎng)不良50例,占47.2%;第4個療程化療后:總營養(yǎng)不良42例,占39.6%,術(shù)后與化療兩組相比有統(tǒng)計學(xué)差異(P0.05)。表明經(jīng)過規(guī)范營養(yǎng)支持治療后,患兒在整個診治過程中,營養(yǎng)不良發(fā)生率逐漸降低。(2)體格檢測值及生化指標(biāo):兩組患兒初診時、實施腫瘤切除術(shù)后以及第四次化療后均監(jiān)測了包括身體監(jiān)測指標(biāo)和血生化指標(biāo),如體重、身高、體質(zhì)指數(shù)(Body mass index,BMI)、中上臂圍(mid-upper arm circumference,MUCA)、三角肌皮褶厚度(skinfold thickness of the triceps,TSFT),血紅蛋白(Hemoglobin,Hb)、Alb(Albumin,白蛋白)、前白蛋白(Prealbumin,Pre-alb)、淋巴細(xì)胞計數(shù)(Lymphocyte count,L)、肌酐(Creatinine,Cr)。兩組患兒在初診時比較均無統(tǒng)計學(xué)差異(P0.05);但實施腫瘤切除術(shù)后:營養(yǎng)支持組BMI、MUCA、TSFT較非營養(yǎng)支持組高(P0.05),血清生化指標(biāo)Hb、Alb、Pre-Alb營養(yǎng)支持組較非營養(yǎng)支持組高(P0.05);術(shù)后第四次化療后:營養(yǎng)支持組各項人體測量指標(biāo)和血清生化指標(biāo)也高于非營養(yǎng)支持組(P0.05)。(3)并發(fā)癥:兩組在手術(shù)過程中均未發(fā)生手術(shù)意外及麻醉意外,術(shù)后營養(yǎng)支持組出現(xiàn)傷口裂開及感染各有1例,非營養(yǎng)支持組5例。營養(yǎng)支持組化療后骨髓抑制、胃腸道功能損害以及呼吸道感染發(fā)生率均低于非營養(yǎng)支持組(P0.05);(4)衛(wèi)生經(jīng)濟(jì)學(xué)指標(biāo):營養(yǎng)支持組平均住院時間比非營養(yǎng)支持組短,營養(yǎng)支持組平均住院次數(shù)低于非營養(yǎng)支持組,營養(yǎng)支持組總住院費(fèi)用比非營養(yǎng)支持組少,營養(yǎng)支持組非計劃再入院率比非營養(yǎng)支持組低。結(jié)論:1.本組資料表明初診的神經(jīng)母細(xì)胞瘤患兒發(fā)生營養(yǎng)不良的比率較高,需要臨床醫(yī)生重視,但在診治過程中,若有規(guī)范營養(yǎng)治療的實施,可以改善患兒營養(yǎng)狀況,使?fàn)I養(yǎng)不良發(fā)生率明顯下降;2.規(guī)范的營養(yǎng)治療能減少NB患兒因手術(shù)、化療帶來的各種并發(fā)癥(如胃腸道反應(yīng),骨髓抑制及傷口裂開和感染等),提高患兒對手術(shù)和化療耐受性。3.規(guī)范的營養(yǎng)治療可以降低NB患兒住院費(fèi)用、減少非計劃再入院率,縮短住院時間、加快病房周轉(zhuǎn),使醫(yī)療資源得到更好的利用。
[Abstract]:Objective: To evaluate the nutritional status of nueroblastoma (NB) in children with early diagnosis, analyze nutrition indicators and nutrition treatment for children with malnutrition, and make a statistical analysis of the incidence of complications after chemotherapy, time of hospitalization, cost and other health economics indicators, and to clarify the importance of nutritional therapy in children with cancer treatment. Methods: in October 2014 -2016 year December, according to the STRONGkids nutritional risk screening and evaluation table, 128 children with middle risk of neuroblastoma were selected, and 22 cases were given up for treatment (8 cases were abandoned after NB, 4 cases were interrupted and 10 cases were interrupted), so only 1 of the children were included in the analysis of this group. 06 cases were divided into 52 cases of nutritional support treatment group and 54 cases of non nutritional support treatment group according to the wishes of family members. The nutritional status of the two groups was evaluated at first visit. The nutritional support group was standardized and continuous nutrition treatment, the postoperative complications of the two groups, the fourth chemotherapy complications, the nutrition index, the average hospitalization time, the average hospitalization times, were analyzed. Total hospitalization expenses, non planned readmission rate and other health economics indicators. Results: (1) dietary survey: among 106 children with early diagnosis of NB, the average intake of energy and protein in all NB children was lower than the daily recommended intake of energy and protein in all children; (2) the changes in the rate of malnutrition at various stages: 60 cases of malnutrition at first visit, accounting for 56.6%, there was no significant difference between the two groups (P0.05). After tumor resection, 50 cases of total dystrophy, 47.2%, fourth courses of chemotherapy, 42 cases of total dystrophy, 39.6%, compared with the two group (P0.05) after the operation (P0.05). The incidence of malnutrition decreased gradually. (2) physical examination values and biochemical indicators: two groups of children were first diagnosed, after the implementation of tumor resection and fourth chemotherapy after the monitoring of the body monitoring indicators and blood biochemical indicators, such as body weight, height, body mass index (Body mass index, BMI), middle arm circumference (mid-upper arm circumference, MUCA), triangle, trigonometry Skinfold thickness of the triceps, TSFT), hemoglobin (Hemoglobin, Hb), Alb (Albumin, albumin), prealbumin (Prealbumin, Pre-alb), lymphocyte count, creatinine. There was no statistical difference between the two groups. Group BMI, MUCA, TSFT were higher than non nutritional support group (P0.05), serum biochemical indexes Hb, Alb, Pre-Alb nutrition support group were higher than non nutritional support group (P0.05); after fourth times chemotherapy, the body measurement index and serum biochemical index of nutrition support group were higher than non nutritional support group (P0.05). (3) complications: the two groups did not occur during the operation process. After operation accident and anesthesia accident, there were 1 cases of wound dehiscence and infection in the postoperative nutrition support group, and 5 cases of non nutritional support group. The bone marrow suppression, gastrointestinal function damage and respiratory infection rate in the nutrition support group were lower than that of non nutritional support group (P0.05), and (4) the average hospitalization time of the nutrition support group was compared with the non nutritional support group. The nutritional support group was shorter than the non nutritional support group, the total hospitalization cost of the nutrition support group was less than that of the non nutritional support group. The non planned readmission rate in the nutrition support group was lower than that of the non nutritional support group. Conclusion: 1. the data of this group showed that the rate of malnutrition in children with first diagnosis of neuroblastoma was higher and needed clinical treatment. Doctors pay attention to it, but in the process of diagnosis and treatment, the nutritional status of children can be improved and the incidence of malnutrition can be reduced obviously by the implementation of standardized nutrition treatment. The 2. standard nutrition treatment can reduce the complications (such as gastrointestinal reaction, bone marrow suppression and wound dehiscence and infection, etc.) in children with NB, and improve the operation of children. And the nutritional therapy of chemotherapy tolerance.3. can reduce the hospitalization cost of NB children, reduce the unplanned readmission rate, shorten the time of hospitalization, speed up the ward turnover, and make the medical resources better utilized.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;兒童神經(jīng)母細(xì)胞瘤診療專家共識[J];中華小兒外科雜志;2015年01期

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本文編號：2077709