渐进式营养指引单在口腔癌患者术后肠内营养的应用研究  

Application of progressive nutrition guide sheet in postoperative enteral nutrition for patients with oral cancer

作　　者：张甜 谯丹 张燕 唐媛 杨雄涛 何洁 赖显洪 肖丽平 李丹 王国蓉 于涛 Zhang Tian;Qiao Dan;Zhang Yan;Tang Yuan;Yang Xiongtao;He Jie;Lai Xianhong;Xiao Liping;Li Dan;Wang Guorong;Yu Tao(Department of Head and Neck Surgery Center,Cancer Hospital Affiliated to School of Medicine,University of Electronic Science and Technology/Sichuan Cancer Control Center;Department of Nursing Research Office,Chengdu 610041,China)

机构地区：[1]电子科技大学医学院附属肿瘤医院/四川省肿瘤医院头颈外科中心,成都610041 [2]电子科技大学医学院附属肿瘤医院/四川省肿瘤医院护理研究室,成都610041

出　　处：《中华临床营养杂志》2021年第1期22-29,共8页Chinese Journal of Clinical Nutrition

基　　金：四川省科技厅重点研发项目:《肿瘤患者评估辅助智能决策系统的建立与实践》(2019YFS0296)四川省科技厅应用基础研究:《口腔鳞癌患者综合序列治疗前后口腔菌群动态变化规律及对患者预后影响的研究》(2019YJ0572)。

摘　　要：目的探讨个体化设计的渐进式营养指引单在口腔癌患者术后肠内营养的应用效果。方法采用方便抽样法,抽取四川省肿瘤医院2017年11月—2018年10月收治入院的口腔癌手术患者40例,采取常规肠内营养支持干预(对照组);2018年11月—2019年10月收治入院的口腔癌手术患者46例,采用个体化设计的渐进式营养指引单进行营养支持干预(观察组);两组患者均需在术后行管饲喂养。比较两组患者术前与术后体重、营养相关指标、胃肠道症状,每天目标能量完成率、患者(或)家属的满意度等。结果两组患者术后7 d的总蛋白与白蛋白、术后3 d和7 d的前白蛋白、术前钾、术后3 d钾和术后3 d钠的差异均有统计学意义(Z=4.963,P<0.01;Z=5.094,P<0.01;Z=-2.022,P<0.05;Z=4.048,P<0.01;Z=2.14,P<0.05,Z=-6.04,P<0.01,Z=-7.13,P<0.01)。两组患者术前、术后3 d、术后7 d钾和钠动态变化差异均有统计学意义(F=30.20,F=118.51,均P<0.01)。两组患者在腹痛、腹胀、腹泻发生率的比较,差异均有统计学意义(χ^(2)=6.91,P=0.009,χ^(2)=10.36,P=0.001,χ^(2)=4.71,P=0.03)。两组患者术后1~6 d目标能量营养完成情况,差异有统计学意义(χ^(2)=41.77,χ^(2)=45.09,χ^(2)=45.71,χ^(2)=40.53,χ^(2)=29.97,χ^(2)=6.11,P均<0.01)。结论渐进式营养指引单在口腔癌患者术后早期肠内营养支持中应用,有助于改善患者术后营养状况,避免钾、钠电解质紊乱,减轻术后胃肠道症状,提高术后每天目标能量完成率及患者(或)家属的满意度,促进疾病康复。Objective To explore the effect of applying individualized progressive nutrition guide sheet in postoperative enteral nutrition(EN)for patients with oral cancer.Methods Using convenient sampling method,40 oral cancer patients admitted to Sichuan Cancer Hospital from November 2017 to October 2018 were selected as the control group,and 46 from November 2018 to October 2019 were selected as the observation group.Both groups received EN support but the observation group were applied with progressive nutrition guide sheet.The pre-and post-operative body weight,nutrition related indicators,gastrointestinal symptoms,proportion of patients achieving daily target energy intake,patient/family satisfaction and other indicators were compared between the two groups.Results There were significant differences in preoperative potassium,total protein and albumin at 7 days after operation,prealbumin at 3 and 7 days after operation,potassium at 3 days after operation and sodium at 3 days after operation between the two groups(Z=4.963,P<0.01;Z=5.094,P<0.01;Z=-2.022,P<0.05;Z=4.048,P<0.01;Z=2.14,P<0.05,Z=-6.04,P<0.01,Z=-7.13,P<0.01).The dynamic changes of potassium and sodium in the two groups were compared before operation,3 days after operation and 7 days after operation(F=30.20,F=118.51,all P<0.01).There were significant differences in incidence of abdominal pain,abdominal distension and diarrhea between the two groups(χ^(2)=6.91,P=0.009,χ^(2)=10.36,P=0.001,χ^(2)=4.71,P=0.03).There were also significant differences in the proportion of patients achieving daily target energy intake at 1 day,2 days,3 days,4 days,5 days,and 6 days after operation between the two groups(χ^(2)=41.77,χ^(2)=45.09,χ^(2)=45.71,χ^(2)=40.53,χ^(2)=29.97,χ^(2)=6.11,all P<0.01).Conclusion The application of progressive nutrition guidelines in early postoperative EN support for patients with oral cancer can help to improve postoperative nutritional status,avoid potassium,sodium and electrolyte disturbance,alleviate postoperative gastrointestinal symptoms

关 键 词：四川省肿瘤医院 胃肠道症状 电解质紊乱 个体化设计 肠内营养支持 口腔癌 疾病康复 前白蛋白 

分 类 号：R473.73[医药卫生—护理学]