本文選題：晚期消化系統(tǒng)腫瘤　切入點(diǎn)：營(yíng)養(yǎng)風(fēng)險(xiǎn)　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:聯(lián)合NRS-2002、PG-SGA兩種方法調(diào)查晚期初治消化系統(tǒng)腫瘤化療患者營(yíng)養(yǎng)狀況,分析兩種方法的適用性,評(píng)估營(yíng)養(yǎng)風(fēng)險(xiǎn)和營(yíng)養(yǎng)不良對(duì)化療后相關(guān)副反應(yīng)發(fā)生率的影響,分析營(yíng)養(yǎng)風(fēng)險(xiǎn)與臨床結(jié)局(包括醫(yī)療總費(fèi)用和住院時(shí)間)之間的關(guān)系,為臨床預(yù)防、治療晚期消化系統(tǒng)腫瘤患者的營(yíng)養(yǎng)不良提供指導(dǎo)依據(jù)。方法:本研究采用前瞻性研究方法,選擇山西醫(yī)科大學(xué)附屬長(zhǎng)治市人民醫(yī)院2016年6月~11月于腫瘤內(nèi)科、普外科、消化內(nèi)科就診的晚期初治消化系統(tǒng)腫瘤99例患者作為研究對(duì)象。當(dāng)天入院后48小時(shí)內(nèi)取得患者及家屬知情同意。收集患者資料包括患者(1)一般情況:姓名、住院號(hào)、床位號(hào)、性別、年齡、入院時(shí)間、出院時(shí)間、住院費(fèi)用;(2)疾病情況:疾病診斷、腫瘤部位、既往治療情況;(3)飲食情況、活動(dòng)情況;(4)體格檢查情況:身高、體重、肌肉丟失情況;(5)實(shí)驗(yàn)室指標(biāo):血紅蛋白、白細(xì)胞、中性粒細(xì)胞、血小板、前清蛋白、清蛋白。隨后進(jìn)行NRS-2002、PG-SGA量表評(píng)定。所有統(tǒng)計(jì)采用SPSS17.0軟件包完成。計(jì)數(shù)資料采用頻數(shù)、率表示,組間比較采用χ2檢驗(yàn)。計(jì)量資料采用(均數(shù)±標(biāo)準(zhǔn)差)或中位數(shù)表示,組間比較采用t檢驗(yàn)或t,檢驗(yàn),或Wilcoxon秩和檢驗(yàn)。一致性分析采用Kappa一致性檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.PG-SGA調(diào)查顯示營(yíng)養(yǎng)不良發(fā)生率50.50%;NRS-2002營(yíng)養(yǎng)風(fēng)險(xiǎn)發(fā)生率37.37%,χ2=8.471,P=0.002,差異有統(tǒng)計(jì)學(xué)意義。PG-SGA、NRS-2002經(jīng)Kappa一致性檢驗(yàn),k=0.657,P0.001,差異有統(tǒng)計(jì)學(xué)意義。以NRS-2002為標(biāo)準(zhǔn),PG-SGA陽(yáng)性預(yù)測(cè)值70%,陰性預(yù)測(cè)值95.92%。2.以NRS-2002結(jié)果分組,BMI在無(wú)營(yíng)養(yǎng)風(fēng)險(xiǎn)組和有營(yíng)養(yǎng)風(fēng)險(xiǎn)組間有統(tǒng)計(jì)學(xué)差異(P0.001)。以PG-SGA結(jié)果分組,前清蛋白、清蛋白在無(wú)營(yíng)養(yǎng)風(fēng)險(xiǎn)組和有營(yíng)養(yǎng)風(fēng)險(xiǎn)組間有統(tǒng)計(jì)學(xué)差異(P=0.032,0.014)。3.全組患者消化道反應(yīng)、疲勞、骨髓抑制的發(fā)生率分別為72.7%、59.6%、60.6%。經(jīng)PG-SGA評(píng)定,營(yíng)養(yǎng)風(fēng)險(xiǎn)越高,惡心/嘔吐的發(fā)生率越高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。存在營(yíng)養(yǎng)風(fēng)險(xiǎn)的患者化療后疲勞、骨髓抑制發(fā)生率有增加的趨勢(shì),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.PG-SGA、NRS-2002兩種篩查結(jié)果中有營(yíng)養(yǎng)風(fēng)險(xiǎn)組較無(wú)營(yíng)養(yǎng)風(fēng)險(xiǎn)組的住院時(shí)間更長(zhǎng),醫(yī)療總費(fèi)用更高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.PG-SGA、NRS-2002都可應(yīng)用于晚期初治消化系統(tǒng)腫瘤患者營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查,但PG-SGA營(yíng)養(yǎng)不良檢出率更高,更利于發(fā)現(xiàn)機(jī)體慢性營(yíng)養(yǎng)狀態(tài)的改變;2.腫瘤患者化療前營(yíng)養(yǎng)風(fēng)險(xiǎn)越高,化療相關(guān)不良反應(yīng)發(fā)生率增加;3.營(yíng)養(yǎng)風(fēng)險(xiǎn)可預(yù)測(cè)臨床結(jié)局。
[Abstract]:Objective: to investigate the nutritional status of patients with advanced digestive system neoplasms treated with PG-SGA combined with NRS-2002PG-SGA, analyze the applicability of the two methods, and evaluate the effects of nutritional risk and malnutrition on the incidence of side effects after chemotherapy.The relationship between nutritional risk and clinical outcome (including total medical expenses and hospital stay) was analyzed to provide guidance for clinical prevention and treatment of malnutrition in patients with advanced digestive system tumors.Methods: a prospective study was conducted on 99 patients with advanced digestive system tumors in Changzhi people's Hospital affiliated to Shanxi Medical University from June to November 2016 in Department of Oncology, General surgery and Department of Digestive Medicine.Informed consent was obtained within 48 hours after admission.The data of the patients were collected including the general information of the patient: name, hospital number, bed number, sex, age, time of admission, time of discharge, cost of hospitalization: disease diagnosis, tumor location, past treatment and diet.Physical examination: height, weight, muscle loss. Laboratory indicators: hemoglobin, white blood cells, neutrophils, platelets, prealbumin, albumin.Then the NRS-2002 PG-SGA scale was evaluated.All statistics were completed by SPSS17.0 software package.The counting data were expressed by frequency and rate, and 蠂 2 test was used for comparison between groups.The measurement data were expressed as (mean 鹵standard deviation) or median. T test, t test, or Wilcoxon rank sum test were used for comparison between groups.Consistency analysis using Kappa consistency test. P05 as the difference was statistically significant.Results: 1. PG-SGA investigation showed that the incidence of malnutrition in NRS-2002 was 37.37% (蠂 ~ 2 / 8.471P ~ (0.002)), the difference was statistically significant (P < 0.05). The difference was statistically significant after the Kappa consistency test (P 0.001).The positive predictive value of PG-SGA was 70 and the negative predictive value of PG-SGA was 95.92.2.According to the results of NRS-2002, there was significant difference between non-nutrition risk group and nutrition risk group (P 0.001).According to the results of PG-SGA, there were significant differences in prealbumin and albumin between non-nutritional risk group and nutritional risk group.The incidence of digestive tract reaction, fatigue and bone marrow suppression were 72.7%, 59.6% and 60.6%, respectively.According to PG-SGA, the higher the nutritional risk, the higher the incidence of nausea and vomiting, and the difference was statistically significant (P 0.05).The incidence of bone marrow suppression increased in patients with nutritional risk after chemotherapy. There was no significant difference between the two screening results (P0.05N. 4. PG-SGAN NRS-2002). The patients with nutritional risk had longer hospital stay and higher total medical cost than those with no nutritional risk.The difference was statistically significant (P 0.05).Conclusion: 1. PG-SGANRS-2002 can be used to screen the nutritional risk of patients with advanced digestive system tumor, but the detection rate of PG-SGA malnutrition is higher, which is more helpful to detect the change of chronic nutritional status.The higher the nutritional risk of cancer patients before chemotherapy, the higher the incidence of chemotherapy-related adverse reactions.Nutritional risk can predict clinical outcome.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735;R730.53

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