儿童神经母细胞瘤营养评估及营养支持治疗的临床研究

发布时间：2018-06-28 10:36

本文选题：儿童 + 神经母细胞瘤　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:评估初诊神经母细胞瘤(nueroblastoma,NB)患儿营养状态,分析营养学指标,对合并营养不良患儿进行营养治疗,并统计其手术后、化疗后并发症发生率及住院时间、费用等卫生经济学指标,阐明肿瘤患儿营养治疗对辅助肿瘤治疗的重要性。方法:2014年10月-2016年12月期间根据STRONGkids营养风险筛查评估表,筛选出中风险以上的神经母细胞瘤患儿共128例,因22例患儿放弃治疗(其中确诊NB后放弃有8例,中断肿瘤治疗4例,中断营养治疗有10例),故纳入本组资料分析的患儿只有106例,依据家属意愿分为营养支持治疗组52例,非营养支持治疗组54例,评估两组患儿初诊时营养状况,对营养支持组进行规范持续的营养治疗,分析两组患儿手术后并发症、第四次化疗后并发症,营养学指标、平均住院时间、平均住院次数,总住院费用、非计划再次入院率等卫生经济学指标。结果:(1)膳食调查:纳入分析的106例初诊NB患儿中,根据膳食调查结果,提示所有NB患儿能量及蛋白质平均摄入量较能量和蛋白质的每日推荐摄入量低;(2)各阶段营养不良患比率的变化:初诊时营养不良60例,占56.6%,两组相比无显著性差异(P0.05);肿瘤切除术后:总营养不良50例,占47.2%;第4个疗程化疗后:总营养不良42例,占39.6%,术后与化疗两组相比有统计学差异(P0.05)。表明经过规范营养支持治疗后,患儿在整个诊治过程中,营养不良发生率逐渐降低。(2)体格检测值及生化指标:两组患儿初诊时、实施肿瘤切除术后以及第四次化疗后均监测了包括身体监测指标和血生化指标,如体重、身高、体质指数(Body mass index,BMI)、中上臂围(mid-upper arm circumference,MUCA)、三角肌皮褶厚度(skinfold thickness of the triceps,TSFT),血红蛋白(Hemoglobin,Hb)、Alb(Albumin,白蛋白)、前白蛋白(Prealbumin,Pre-alb)、淋巴细胞计数(Lymphocyte count,L)、肌酐(Creatinine,Cr)。两组患儿在初诊时比较均无统计学差异(P0.05);但实施肿瘤切除术后:营养支持组BMI、MUCA、TSFT较非营养支持组高(P0.05),血清生化指标Hb、Alb、Pre-Alb营养支持组较非营养支持组高(P0.05);术后第四次化疗后:营养支持组各项人体测量指标和血清生化指标也高于非营养支持组(P0.05)。(3)并发症:两组在手术过程中均未发生手术意外及麻醉意外,术后营养支持组出现伤口裂开及感染各有1例,非营养支持组5例。营养支持组化疗后骨髓抑制、胃肠道功能损害以及呼吸道感染发生率均低于非营养支持组(P0.05);(4)卫生经济学指标:营养支持组平均住院时间比非营养支持组短,营养支持组平均住院次数低于非营养支持组,营养支持组总住院费用比非营养支持组少,营养支持组非计划再入院率比非营养支持组低。结论:1.本组资料表明初诊的神经母细胞瘤患儿发生营养不良的比率较高,需要临床医生重视,但在诊治过程中,若有规范营养治疗的实施,可以改善患儿营养状况,使营养不良发生率明显下降;2.规范的营养治疗能减少NB患儿因手术、化疗带来的各种并发症(如胃肠道反应,骨髓抑制及伤口裂开和感染等),提高患儿对手术和化疗耐受性。3.规范的营养治疗可以降低NB患儿住院费用、减少非计划再入院率,缩短住院时间、加快病房周转,使医疗资源得到更好的利用。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4

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