唐毅;王惠群;王黔;杨芳;杨雯雁;刘应洁;张莉娜;杨大刚;
TANG Yi;WANG Huiqun;WANG Qian;YANG Fang;YANG Wenyan;LIU Yingjie;ZHANG Lina;YANG Dagang;School of Public Health,Guizhou Medical University;Department of Gastroenterology,the Affiliated Hospital of Guizhou Medical University;School of Inspection,Guizhou Medical University;Department of Clinical Nutrition,the Affiliated Hospital of Guizhou Medical University;

• 1:贵州医科大学公共卫生学院
• 2:贵州医科大学附属医院胃肠外科
• 3:贵州医科大学检验学院
• 4:贵州医科大学附属医院临床营养科

摘要(Abstract)：

目的:探讨院外营养干预对胃癌术后患者营养状况的影响。方法:选择胃癌术后患者108例,分为对照组(n=53,常规出院指导和随访)和试验组(n=55,院外个性化营养干预和随访),收集2组患者出院前的一般资料(性别、年龄、民族、婚姻、职业、学历、饮酒史、吸烟史、慢性病史及临床分期),采用营养风险筛查2002(NRS2002)量表评分、患者参与的主观全面评定(PG-SGA)量表评分及体质量指数(BMI)评估患者出院前和出院1个月返院化疗时的营养状况,比较出院前和出院后1个月时2组患者血液总蛋白、白蛋白、前白蛋白、淋巴细胞及血红蛋白等营养指标。结果:出院后1个月,2组胃癌术后患者BMI、NRS2002及PG-SGA评分均低于出院前,差异均有统计学意义(P <0.05); 2组组间比较,试验组胃癌术后患者BMI高于对照组,而NRS2002和PGSGA评分低于对照组,差异均有统计学意义(P <0.05);与出院时相比,出院后1个月2组胃癌术后患者的总蛋白、白蛋白、前白蛋白、淋巴细胞及血红蛋白均明显升高,且试验组总蛋白、白蛋白、前白蛋白、淋巴细胞及血红蛋白均高于对照组、差异有统计学意义(P <0.05)。结论:院外营养干预有助于改善胃癌术后患者出院后的营养状况。
Objective: To investigate the effect of out-of-hospital nutrition intervention on nutritional status of patients with gastric cancer after operation. Methods: A total of 108 patients with gastric cancer after surgery were selected as the research subjects,and randomly divided into the control group( n = 53,routine discharge guidance and follow-up) and the experimental group( n = 55,personalized nutrition intervention and follow-up). The basic data of the patients were collected before discharge.Measurement and collection were conducted,including body mass index( BMI),Nutrition risk screening 2002( NRS2002), Patient-Generated Subjective Global Assessment( PG-SGA) and nutrition indicators total protein,albumin,prealbumin,Lymphocytes,hemoglobin before and 1 month after discharge from hospital. Results: One month after discharge,the BMI,NRS2002,and PG-SGA of two groups were lower than before discharge,and the difference was statistically significant( P <0. 05). The BMI of the experimental group was higher than that in the control group,and the NRS2002 and PG-SGA of the experimental group were lower than those of the control group,and the difference was statistically significant( P < 0. 05). One month after discharge from hospital,the total protein,albumin,prealbumin,lymphocytes,and hemoglobin of the two groups increased,except for the total protein and lymphocytes of the control group,with statistical significance( P < 0. 05). The total protein,albumin,prealbumin,lymphocytes,and hemoglobin in the experimental group were higher than those in the control group,and the differences were statistically significant( P < 0. 05).Conclusion: Out-of-hospital nutrition intervention is helpful to the improvement of the nutritional status of out-of-hospital patients with gastric cancer.

关键词(KeyWords)： 胃肿瘤;胃切除术;营养干预;营养风险筛查2002;患者参与的主观全面评定;营养状况
stomach neoplasms;gastrectomy;nutrition intervention;nutritional risk screening 2002(NRS2002);patient-generated subjective global assessment(PG-SGA);nutritional status

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅基金[黔科合SZ字(2014)3021]

作者(Author): 唐毅;王惠群;王黔;杨芳;杨雯雁;刘应洁;张莉娜;杨大刚;
TANG Yi;WANG Huiqun;WANG Qian;YANG Fang;YANG Wenyan;LIU Yingjie;ZHANG Lina;YANG Dagang;School of Public Health,Guizhou Medical University;Department of Gastroenterology,the Affiliated Hospital of Guizhou Medical University;School of Inspection,Guizhou Medical University;Department of Clinical Nutrition,the Affiliated Hospital of Guizhou Medical University;

Email:

DOI: 10.19367/j.cnki.2096-8388.2020.08.015

参考文献(References)：

• [1]左婷婷，郑荣寿，曾红梅，等．中国胃癌流行病学现状[J]．中国肿瘤临床，2017,44(1):52-58．
• [2]陈孝平，汪建平，赵继宗．外科学[M]．北京:人民卫生出版社，2018:345-349．
• [3]芮红霞，郑红霞，徐玉兰，等．胃癌手术患者营养风险筛查及营养支持现况分析[J]．安徽医学，2015,36(10):1190-1193．
• [4]FEIJP M,RODRIGUES V D,VIANA M S,et al.Effects ofω-3 supplementation on the nutritional status,immune,and inflammatory profiles of gastric cancer patients:a randomized controlled trial[J].Nutrition,2019,61:125-131．
• [5]王洁．对接受胃癌根治术后的老年患者进行早期肠内营养支持对其营养状况及康复质量的影响[J]．当代医药论丛，2019,17(19):250-252．
• [6]陶慧，杜道丽．早期营养护理改善胃癌术后患者各类营养评估指标效果分析[J]．临床医药文献电子杂志，2019,6(69):105．
• [7]SEO H S,JUNG Y J,KIM J H,et al.Long-term nutritional outcomes of near total gastrectomy in the treatment of gastric cancer:a comparison with total gastrectomy using propensity score matching analysis[J].Gastric Cancer,2018,18(2):189-199．
• [8]高慧坚．参与式饮食护理对胃癌根治术后患者饮食依从性及营养状态的影响[J]．临床合理用药杂志，2019,12(35):134-135．
• [9]马千惠．胃癌术后患者家庭肠内营养支持的现况调查[D]．北京:北京协和医学院，2019．
• [10]付恩锋，和芳，李彩云，等．加强饮食干预对快速康复胃癌术后患者营养状况的影响[J]．中国肿瘤临床与康复，2019,26(1):92-96．
• [11]KONDRUP J,RASMUSSEN H H,HAMBERG O,et al.Nutritional risk screening (NRS 2002):a new method based on an analysis of controlled clinical trials[J].Clinical Nutrition,2003,22(3):321-336．
• [12]OTTERY F D.Rethinking nutritional support of the cancer patient:the new field of nutritional oncology[J].Seminars in Oncology,1994,21(6):770-778．
• [13]NIE Y,WU K,YU J,et al.A global burden of gastric cancer:the major impact of China[J].Expert review of Gastroenterology&Hepatology,2017,11(7):651-661．
• [14]FENG R M,ZONG Y N,CAO S M,et al.Current cancer situation in China:good or bad news from the 2018 Global Cancer Statistics[J].Cancer Communications,2019,39(1):1-12．
• [15]王杰，陈友红，许艺莲，等．胃癌患者个体化延续性护理需求及影响因素[J]．世界华人消化杂志，2018,26(1):4-9．
• [16]ABDIEV S,KODERA Y,FUJIWARA M,et al.Nutritional recovery after open and laparoscopic gastrectomies[J].Gastric Cancer,2011,14(2):15-27．
• [17]辛晓伟，方玉，龚丽青，等．全程营养管理在晚期胃癌化疗病人中的应用[J]．肠外与肠内营养，2019,26(4):193-197．
• [18]黄英隆，高洁，吴日英，等．胃癌病人围术期营养知识调查[J]．护理研究，2015,29(3):343-344．
• [19]YUTAKA K,KAZUHIRO N,KENTARO K,et al.Longterm effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients (KSES002)[J].Annals of Gastroenterological Surgery,2019,3(6):115-129．
• [20]陈美燕．基于NRS2002的个体化营养管理方案对胃癌术后化疗患者营养状况和生命质量的影响[D]．南宁:广西医科大学，2019．
• [21]ZHEN Y J,JUN Y,DA N T,et al.Screening of nutritional risk and nutritional support in general surgery patients:a survey from shanghai,China[J].International Surgery,2015,100(5):1-15．
• [22]闫国林．血清前白蛋白与胃癌患者预后的关系研究[D]．蚌埠:蚌埠医学院，2019．
• [23]杭凌云．基于自评-主观全面评定量表的营养干预对胃癌术后患者能量摄入量和营养改善的效果分析[J]．护理实践与研究，2019,16(19):98-99．
• [24]金琳华，马宁．术后持续性护理模式对行胃癌根治术患者生活质量及营养指标的影响[J]．世界华人消化杂志，2018,26(11):661-666．
• [25]汪丹丹，郑蔚，乔婷婷，等．胃癌术后患者参与饮食管理对其营养状况影响的研究[J]．中华护理杂志，2017,52(4):389-394．
• [26]PARK S H,LEE S,SONG J H,et al.Prognostic significance of body mass index and prognostic nutritional index in stage II/III gastric cancer[J].European Journal of Surgical Oncology,2019,3(1):152-168．
• [27]李林娟，汪秀云，牟倩倩，等．基于互联网的营养支持小组对胃癌化疗病人营养状态的干预效果研究[J]．安徽医药，2019,23(10):1983-1987.

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