喉癌患者营养风险筛查及个体化营养干预的效果评价

摘要

目的:评估喉癌患者营养风险并探讨个体化营养干预对喉癌患者的效果.方法:于2012年1月-2016年12月选取四川省宜宾市第二人民医院和四川省肿瘤医院住院治疗的553例喉癌患者,采用营养风险筛查工具(NRS 2002)评估其营养风险,并将存在营养风险的262例患者随机分为干预组(140例)和对照组(122例),分别给予个体化(根据具体情况选择肠内营养或肠外营养,总能量、蛋白质的估计以及营养制剂的合理选择等)和家属自备匀浆制剂营养支持,观察并比较其一般住院指标、营养状况指标和远期生存质量等.结果:553例喉癌患者存在营养风险者262例,营养风险发生率47.4％;干预组住院时间、咽瘘发生率和术后放化疗率均低于对照组(P＜0.05);干预组干预后营养相关指标(体重、白蛋白、前白蛋白、血红蛋白和淋巴细胞总数)优于干预前(P＜0.05),营养相关指标干预前后差值干预组优于对照组(P＜0.05);癌症治疗功能评价系统专用头颈量表(FACT-HN)评分干预组高于对照组(P＜0.05).结论:喉癌患者营养风险发生率较高,积极个体化的营养支持不仅缩短住院时间、降低术后并发症、改善患者营养状况甚至提高患者远期生存质量,有必要对喉癌患者制定个体化营养支持方案,提高预后和远期生存质量.%[Objective] To screen nutrition risk of laryngeal cancer patients and assess the effects of personalized nutrition intervention.[Method] From January 2012 to December 2016,553 laryngeal cancer inpatients were selected from Yibin No.2 People's hospital and Sichuan cancer hospital to screen nutrition risk by Nutrition Risk Screening 2002 (NRS 2002),262 patients with nutrition risk were divided into intervention groups (n =140) and control group (n =122),and respectively given with personalized nutrition supports (enteral nutrition or parenferal nutrition,total energy and protein assessment,nutraceuticals selection) and family-prepared homogenate nutrient solution,finally the general hospitalization index,nutritional status and long-term life quality were observed.[Result] The incidence rate of nutrition risk was 47.4％(262/553) among laryngeal cancer patients.The hospitalization duration,incidence rate of pharyngeal fistula and postoperative radiotherapy and chemotherapy rate of intervention group were significantly lower than those of control group (P ＜ 0.05).The nutrition related indexes of after nutrition intervention were better than those of before intervention (P ＜0.05),the difference before and after intervention in intervention group was significantly superior than control group (P ＜ 0.05).The functional assessment of cancer therapy-head and neck (FACT-HN) score of intervention group was higher than control group (P ＜0.05).[Conclusion] The incidence rate of nutrition risk is high among laryngeal cancer patients.Positive personalized nutrition support could shorten hospitalized duration,reduce postoperative complications,improve nutritional status and long-term life quality of the patients,so it is essential to develop an individualized nutrition support scheme for laryngeal cancer patients to improve prognosis and long-term quality of life.