全程精细化营养支持对老年食管癌同步放化疗患者营养状况及近期生命质量的影响
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摘要
目的分析全程精细化营养支持对老年食管癌同步放化疗患者营养状况及近期生命质量的影响。方法采用随机数表法将本院2017年1月至2018年12月收治的60例老年食管癌患者分别纳入研究组(31例)和对照组(29例)。两组患者均接受同步放化疗,对照组患者接受常规营养宣教和饮食指导,研究组患者接受全程精细化营养支持。同步放化疗结束后2 d,分别使用患者整体营养状况主观评估量表(patient-generated subjective global assessment,PG-SGA)及欧洲癌症研究与治疗组织开发的生活质量核心量表(European Organization for Research and Treatment of Cancer quality of life questionnaire-cancer,EORTCQLQ-C30)评估两组患者营养状况及生命质量,并对比两组患者治疗前后血红蛋白(hemoglobin,Hb)、前白蛋白(prealbumin,PAB)、白蛋白(albumin,ALB)、转铁蛋白(transferrin,TRF)水平。结果治疗后2 d,两组严重营养不良患者占比和PGSGS评分均显著高于本组治疗前(均P <0.05),Hb、PAB、ALB、TRF水平均显著低于本组治疗前(均P <0.05);研究组严重营养不良患者占比和PG-SGS评分均显著低于对照组(均P <0.05),Hb、PAB、ALB、TRF水平均显著高于对照组(均P <0.05)。研究组患者治疗后2 d生命质量各领域评分与治疗前相比均无显著变化(均P> 0.05),对照组患者治疗后2 d生命质量各领域评分均显著低于本组治疗前及同期研究组(均P <0.05)。结论全程精细化营养支持能够减轻同步放化疗对老年食管癌患者营养状况和生命质量带来的负面影响,值得推广应用。
Objective To analyze the effect of whole-process refined nutrition support on nutritional status and short-term quality of life of elderly patients with esophageal cancer undergoing concurrent chemoradiotherapy. Method 60 elderly patients with esophageal cancer admitted to our hospital from January 2017 to December 2018 were enrolled in study group(31 cases) and control group(29 cases). Both groups received concurrent chemoradiotherapy, control group patients were received routine nutrition education and dietary guidance, while study group patients were received whole-process refined nutrition support. Two days after concurrent radiotherapy and chemotherapy, the nutritional status and quality of life of patients in the two groups were assessed by patient-generated subjective global assessment(PG-SGA) and European Organization for Research and Treatment of Cancer quality of life questionnairecancer(EORTC-QLQ-C30), and the changes of hemoglobin(Hb), prealbumin(PAB), albumin(ALB), transferrin(TRF) before and after treatment were compared between the two groups. Result Two days after treatment, the proportion of severe malnutrition patients and PG-SGS scores in both groups were significantly higher than those before treatment(all P < 0.05), and the levels of Hb,PAB, ALB and TRF were significantly lower than those before treatment(all P < 0.05); the proportion of severe malnutrition patients and PG-SGS scores in study group were significantly lower than those in control group(all P < 0.05), and the levels of Hb, PAB, ALB and TRF were significantly higher than those in control group(all P < 0.05). There were no significant changes in EORTC-QLQ-C30 scores before and 2 days after treatment in study group(all P > 0.05), while the EORTC-QLQ-C30 scores in control group 2 days after treatment were significantly lower than those before treatment and at the same time of study group(all P < 0.05). Conclusion The whole-process refined nutrition support can reduce the negative impact on nutritional status and quality of life of elderly patients with esophageal cancer undergoing concurrent chemoradiotherapy, which is worthy of popularization and application.
Objective To analyze the effect of whole-process refined nutrition support on nutritional status and short-term quality of life of elderly patients with esophageal cancer undergoing concurrent chemoradiotherapy. Method 60 elderly patients with esophageal cancer admitted to our hospital from January 2017 to December 2018 were enrolled in study group(31 cases) and control group(29 cases). Both groups received concurrent chemoradiotherapy, control group patients were received routine nutrition education and dietary guidance, while study group patients were received whole-process refined nutrition support. Two days after concurrent radiotherapy and chemotherapy, the nutritional status and quality of life of patients in the two groups were assessed by patient-generated subjective global assessment(PG-SGA) and European Organization for Research and Treatment of Cancer quality of life questionnairecancer(EORTC-QLQ-C30), and the changes of hemoglobin(Hb), prealbumin(PAB), albumin(ALB), transferrin(TRF) before and after treatment were compared between the two groups. Result Two days after treatment, the proportion of severe malnutrition patients and PG-SGS scores in both groups were significantly higher than those before treatment(all P < 0.05), and the levels of Hb,PAB, ALB and TRF were significantly lower than those before treatment(all P < 0.05); the proportion of severe malnutrition patients and PG-SGS scores in study group were significantly lower than those in control group(all P < 0.05), and the levels of Hb, PAB, ALB and TRF were significantly higher than those in control group(all P < 0.05). There were no significant changes in EORTC-QLQ-C30 scores before and 2 days after treatment in study group(all P > 0.05), while the EORTC-QLQ-C30 scores in control group 2 days after treatment were significantly lower than those before treatment and at the same time of study group(all P < 0.05). Conclusion The whole-process refined nutrition support can reduce the negative impact on nutritional status and quality of life of elderly patients with esophageal cancer undergoing concurrent chemoradiotherapy, which is worthy of popularization and application.
引文
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[15]Yoshida N,Baba Y,Shigaki H,et al.Preoperative nutritional assessment by controlling nutritional status(CONUT)is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer[J].World J Surg,2016,40(8):1910-1917.
[16]Van Laethem JL,Carneiro F,Ducreux M,et al.The multidisciplinary management of gastro-oesophageal junction tumours:European Society of Digestive Oncology(ESDO):Expert discussion and report from the 16th ESMO World Congress on Gastrointestinal Cancer,Barcelona[J].Dig Liver Dis,2016,48(11):1283-1289.
[17]孙永叶.心理护理联合微信干预对冠心病患者负性情绪的影响[J].国际护理学杂志,2017,36(24):3401.
[18]姚志翠.微信随访干预对维持性血液透析患者营养状况的影响研究[D].石家庄:河北医科大学,2016.
[2]Clavier JB,Antoni D,Atlani D,et al.Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer[J].Dis Esophagus,2014,27(6):560-567.
[3]Hong JS,Wu LH,Su L,et al.Effect of chemoradiotherapy on nutrition status of patients with nasopharyngeal cancer[J].Nutr Cancer,2016,68(1):63-69.
[4]薛志芳,武雪亮,王丽,等.全程精细化营养管理对老年食管癌同步放化疗患者营养状况、免疫功能及生活质量的影响[J].中国老年学杂志,2019,39(6):1331-1334.
[5]Wiegert EVM,Padilha PC,Peres WAF.Performance of PatientGenerated Subjective Global Assessment(PG-SGA)in Patients With Advanced Cancer in Palliative Care[J].Nutr Clin Pract,2017,32(5):675-681.
[6]Chie WC,Hong RL,Lai CC,et al.Quality of life in patients of nasopharyngeal carcinoma:validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35[J].Qual Life Res,2003,12(1):93-98.
[7]于红.三种不同营养方式在老年食管癌患者术后早期康复中应用效果[J].实用临床医药杂志,2016,20(2):161-162.
[8]虞桂平,陈国强,黄斌.老年食管癌患者术后早期肠内营养对营养状况及免疫功能的影响[J].中华胸心血管外科杂志,2016,32(9):569-573.
[9]罗爱国,黎光强,潘禹辰,等.围手术期肠内与肠外营养对老年食管癌术后转归的影响[J].当代医学,2016,22(18):34-36.
[10]刘春芳,王万霞,黄兰,等.老年食管癌患者不同时间段营养状态及相关因素[J].中国老年学杂志,2017,37(16):4000-4002.
[11]毛青青,刘莹.早期肠内营养干预对晚期食管癌同步放化疗患者肠黏膜屏障功能及营养状况的影响[J].世界华人消化杂志,2019,27(2):101-106.
[12]李明涛,张达.围术期肠内营养对老年食管癌患者术后转归的影响研究[J].检验医学与临床,2016,13(20):2935-2936.
[13]Bracken-Clarke D,Farooq AR,Horgan AM.Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population[J].Curr Oncol Rep,2018,20(12):99.
[14]Mak M,Bell K,Ng W,et al.Nutritional status,management and clinical outcomes in patients with esophageal and gastrooesophageal cancers:A descriptive study[J].Nutr Diet,2017,74(3):229-235.
[15]Yoshida N,Baba Y,Shigaki H,et al.Preoperative nutritional assessment by controlling nutritional status(CONUT)is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer[J].World J Surg,2016,40(8):1910-1917.
[16]Van Laethem JL,Carneiro F,Ducreux M,et al.The multidisciplinary management of gastro-oesophageal junction tumours:European Society of Digestive Oncology(ESDO):Expert discussion and report from the 16th ESMO World Congress on Gastrointestinal Cancer,Barcelona[J].Dig Liver Dis,2016,48(11):1283-1289.
[17]孙永叶.心理护理联合微信干预对冠心病患者负性情绪的影响[J].国际护理学杂志,2017,36(24):3401.
[18]姚志翠.微信随访干预对维持性血液透析患者营养状况的影响研究[D].石家庄:河北医科大学,2016.