全病程MDT营养管理对老年食管癌患者放疗进程的影响  

Effects of whole-course MDT nutrition management on radiotherapy in elderly patients with esophageal cancer

作　　者：隋婧婧 张洪明[2] 王子国 李险峰[2] Jingjing Sui;Hongming Zhang;Ziguo Wang;Xianfeng Li(Shanxi Medical University,The First Hospital of Shanxi Medical University,Taiyuan 030000,China;Department of Radiotherapy,The First Hospital of Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西医科大学,太原市030000 [2]山西医科大学第一医院放疗科

出　　处：《中国肿瘤临床》2020年第1期29-33,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探究全病程多学科诊疗模式(multidisciplinary team,MDT)营养管理对老年食管癌患者放疗进程的影响。方法:收集山西医科大学第一医院2018年1月至2019年9月经病理证实为食管鳞癌的老年患者60例,随机分为对照组(30例)与实验组(30例),均行放疗,对照组给予常规营养干预,实验组给予全病程MDT营养干预,统计患者BMI、营养状况、不良反应发生率、治疗时间等。结果:对照组患者PG-SGA评分、中-重度营养不良发生率较实验组(86.3%vs.70%)明显升高;放疗后患者主观综合营养评估法(patient-generated subjective global assessment,PG-SGA)评分较放疗前升高,且对照组升高更明显(P<0.05);对照组总蛋白(total protein,TP)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)先下降后上升,而实验组较平稳或逐渐上升;对照组放疗后血液学指标白细胞(white blood cell,WBC)、血红蛋白(hemoglobin,HB)下降较实验组明显,且WBC的下降差异有统计学意义(P<0.05);与对照组相比,实验组ALB、PA、TP、BMI放疗后升高(P<0.05),2级以上急性黏膜反应(13.3%)、骨髓抑制(26.3%)发生率低(P<0.05),生活质量好(P<0.05),且总治疗时间[(41.97±2.59)d]短(P<0.05)。结论:全病程MDT营养管理明显改善患者营养不良状况,减少不良反应发生率及总治疗时间,提升生存质量。Objective:To explore the effect of MDT nutrition management on the radiotherapy process of elderly patients with esophageal cancer.Methods:From January 2018 to September 2019,60 elderly patients with esophageal squamous cell carcinoma were selected,and randomly divided into the control group(Group A,30 cases)and the experimental group(Group B,30 cases).All the groups received radiotherapy in The First Hospital of Shanxi Medical Univesity.The Group A was treated with routine nutrition intervention and the Group B with multidisciplinary team(MDT)nutrition intervention.Body mass index(BMI),nutritional status,the incidence of adverse reactions and treatment time were eraluated respectively.Results:The patient-generated subjective global assessment(PG-SGA)score and the incidence of moderate to severe malnutrition in Group A(86.3%)were significantly higher than those in Group B(70%);the PG-SGA score after radiotherapy was higher than that before radiotherapy in both groups,and it was evidently higher in Group A(P<0.05).Total protein(TP),albumin(ALB)and prealbumin(PA)decreased first and then increased in Group A,but they increased steadily or gradually in Group B.WBC and Hb decreased significantly in Group A compared with those in Group B(P<0.05).In comparison with Group A,the levels of ALB,PA,TP and BMI in Group B were increased after radiotherapy(P<0.05),the incidence of acute mucosal reaction above grade II(13.3%)and myelosuppression(26.3%)was lower(P<0.05),the quality of life was better(P<0.05)and the total treatment time was shorter[(41.97±2.59)d](P<0.05).Conclusions:The total course of MDT nutrition management significantly improved malnutrition,reduced the incidence of adverse reactions and total treatment time,and improved the quality of life.

关 键 词：全病程管理 食管癌 放疗 营养干预 不良反应 

分 类 号：R735.1[医药卫生—肿瘤]