鼻咽癌放疗患者营养状况的影响因素研究

发布时间：2018-04-03 17:07

  本文选题：鼻咽癌　切入点：放疗　出处：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1.明确鼻咽癌患者在放疗前、中、后三个时期的营养、饮食摄入量、疼痛程度、放疗不良反应及心理状态的情况和其相应的变化趋势。2.分析鼻咽癌放疗患者的一般资料、饮食摄入量、疼痛程度、放疗不良反应及心理状态对其营养状况的影响,探讨放疗期间鼻咽癌患者营养状况的影响因素,为临床上制定相应的营养干预方案提供科学依据。[方法]选择2015年12月～2016年12月在昆明医科大学第三附属医院符合条件的鼻咽癌放疗患者,采用患者自身前后对照的方法,使用统一的调查表,调查患者的一般资料,主要内容包括:性别、年龄、居住地、家庭人均收入、职业、婚姻状况、文化程度、既往病史、吸烟饮酒史、TNM分期、病理类型、化疗史、放疗方式和剂量。并在放疗前、放疗第4周及放疗后对患者的营养状况、饮食摄入量、疼痛程度、放疗不良反应及心理状态进行调查,动态评估并分析鼻咽癌放疗患者的营养状况及其影响因素。单因素分析采用X2检验,多因素分析采用二元Logistic回归模型,P0.05为有统计学意义。[结果]1.共有44例患者符合纳入排除标准,在放疗前有11例(25%)患者有营养不良或存在营养风险,重度营养不良患者仅1例(2%),接受放疗后,营养不良的患者高达73%,且大部分为重度营养不良(66%)。2.配对t检验结果显示:患者的营养指标,如体质指数、血清白蛋白、血清前白蛋白、淋巴细胞计数、血清转铁蛋白,在放疗后均较放疗前下降,差异有统计学意义(P0.001)。3.患者的饮食摄入量、焦虑抑郁评分、疼痛评分及放疗不良反应发生率在放疗前后的变化均具有统计学意义(P0.05)。4. x2检验结果显示:同步化疗、饮食减少≥1/2、抑郁为放疗期间鼻咽癌患者营养状况的影响因素。Logistic回归分析显示:同步化疗、饮食减少≥1/2是放疗期间鼻咽癌患者营养状况的独立影响因素。[结论]1.鼻咽癌患者营养不良的发生率高,在接受放疗后其营养状况进一步加剧,且在放疗期间患者的相关营养指标不断下降。2.随着放疗次数和剂量的增加,患者的饮食摄入量明显减少,焦虑、抑郁、疼痛的评分逐渐增加,发生放疗不良反应的患者增多。3.同步化疗、饮食减少≥1/2是放疗期间鼻咽癌患者营养状况的独立影响因素。4.积极做好鼻咽癌患者放疗前、中、后营养状况的筛查和评估,尤其是需行同步化疗及饮食减少≥1/2的患者,以便尽早发现患者的营养问题并实施有效的营养干预可望改善鼻咽癌患者放疗期间的营养状况,减少营养不良的发生,提高生活质量,改善预后。
[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，

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