99例胃癌患者营养现状及营养支持治疗的调查研究

发布时间：2018-02-21 15:20

本文关键词： 胃癌患者患者主观整体评估 NRS2002 营养不良营养支持治疗　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:运用患者主观整体评估(patient-generated subjective global assessment,PG-SGA)方法对邢台市人民医院住院的胃癌患者进行营养现状及营养支持治疗进行调查,了解邢台市人民医院胃癌患者营养现状及营养支持治疗情况。方法:1本研究随机选取调查2013年6月至2014年12月邢台市人民医院肿瘤内科病理诊断确诊胃癌并接受化疗一个月的胃癌患者,并且对符合纳入标准的患者进行营养现状及营养支持治疗调查。用PG-SGA作为营养现状评估工具,具体内容包括胃癌患者体重指数、摄食情况、症状、活动和身体功能、疾病与营养需求的关系、代谢方面的需要、体格检查等7个方面评估营养状况。2数据的收集与分析方法数据的描述与分析使用SPSS13.0。搜集到的临床数据采用统计描述,首先对各实验组进行正态性与方差齐性检验,如果独立样本的数据服从正态性与方差齐性,计量资料以(?x±s)表示,采用t检验;相关性如果数据符合双变量正态性,采用Pearson线性相关分析,如不满足应用条件则采用Spearman秩相关进行相关分析。三个或三个以上独立样本的比较采用完全独立多样本比较的单因素方差分析,方差分析有差异,如进一步的两两比较,采用LSD法进行。如果资料不满足正态性与方差齐性,则采用多个独立样本比较Kruskal-Wallis H非参数检验,进一步的两两比较采用秩转换的方差分析。检验水准设定为α=0.05,以P0.05认为差异具有统计学意义。结果:1本研究共纳入99例胃癌患者,其中男性73例(73.73%),女性26例(26.37%);营养良好者5例(5.06%),轻度/中度营养不良54例(54.54%),重度营养不良40例(40.40%);有营养支持43例(43.43%),无营养支持56例(56.57%)。肠内营养联合肠外营养支持9例(9.09%),单纯肠内营养支持17例(17.17%),单纯肠外营养支持17例(17.17%)。2营养良好患者与轻度/中度营养不良及重度营养不良患者年龄分布均有所不同,差异具有统计学意义(P0.05);重度营养不良患者与轻度/中度营养不良及营养良好患者BMI值均有所不同,差异具有统计学意义(P0.05)。3 PG-SGA总评分(病人)与PG-SGA(医务人员)定量评价的相关性研究表明营养状况良好患者、轻中度营养不良患者及重度营养不良患者其相关性分别为0.97、0.90、0.96,P值均为0.00,相关性显著并且具有统计学意义(P0.05)。NRS2002评分同住院总时间有相关性,相关系数为0.22,具有统计学意义(P0.05)。4各组患者住院费用分析,营养良好患者平均住院花费12148元、轻度/中度营养不良患者平均住院花费20293元、重度营养不良患者平均住院花费24189元,营养良好患者与重度营养不良患者住院花费有所不同,差异具有统计学意义(P0.05)。5营养治疗患者BMI指数分析,肠内外联合治疗患者与单纯肠内营养治疗患者及单纯肠外营养治疗患者BMI指数总体分布相同,差异无统计学意义(P0.05)。营养治疗患者住院费用分析,肠内外联合治疗患者平均住院花费45933元、单纯肠内营养治疗患者平均住院花费8012元、单纯肠外营养治疗患者平均住院花费38603元,单纯肠内营养治疗患者住院费用与肠内外联合治疗患者及单纯肠外营养治疗患者住院花费均有所不同,差异具有统计学意义(P0.05)。6营养治疗患者血清生化指标分析,血清白蛋白水平(36.27±4.66)g/L、总蛋白水平61.04±9.34 g/L;未经营养治疗后患者血清白蛋白38.71±5.92 g/L、总蛋白水平66.82±8.08 g/L;以上两项结果均存在差异,有统计学意义(P0.05)。7营养治疗患者BMI指数为(19.52±3.06)kg/m2,三头肌皮褶厚度(TSF)为7.20±3.70mm,上臂肌肉周径(MAMC)为18.44±6.89 cm;未经营养治疗患者BMI指数为21.72±3.44 kg/m2,三头肌皮褶厚度(TSF)为9.52±5.41mm,上臂肌肉周径(MAMC)为21.18±4.61cm,以上三项结果均存在差异,有统计学意义(P0.05)。8营养治疗和未经营养治疗患者年龄分布结果为(63.56±10.25)岁和62.81±10.41岁,差异无统计学意义(P0.05)。营养治疗患者卡氏评分和NRS2002定量结果分别为68.60±15.21、57.00±11.34,未经营养治疗患者卡氏评分和NRS2002定量结果分别为84.07±10.37、52.39±8.29,以上两项结果差异均有统计学意义(P0.05)。结论:住院胃癌患者营养不良发生率较高,重度营养不良患者BMI水平降低明显、住院花费较高;住院胃癌患者肠内外联合营养支持治疗的使用率低;纳入营养支持治疗的患者自身处于恶病质状态,一方面食欲不振,另一方面即使补充营养效果也不显著,患者血清白蛋白水平、总蛋白水平、BMI指数、三头肌皮褶厚度(TSF)和上臂肌肉周径均较未经营养治疗患者有所降低。体质指标处于未接受营养治疗患者95%可信区间临界值以内无论自身感觉营养状况良好与否,都建议给予临床营养支持。鉴于上述指标对机体恢复相对敏感,可以作为今后营养支持成功与否的临床观察指标。
[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.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2;R459.3

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