癌症患者疼痛量表的应用

癌痛本质上是患者的主观感受,因此患者的疼痛表述是评估的依据,患者自评量表也由此在临床实践和研究中被广泛采用。一维量表常用于评估癌痛的强度,其中的数字评估量表（Numerical Rating Scale,NRS）被欧洲姑息治疗研究协作组所推荐;多维量表,如简式疼痛问卷（Brief Pain Inventory,BPI）或修订后的简式麦吉尔疼痛问卷（Short-Form McGill Pain Questionnaire,SF-MPQ-2）可更全面的评估癌痛;评估肿瘤患者的爆发痛、神经病理性疼痛时可选择有针对性的量表;对认知功能受损的患者,脸谱法评估有助于癌痛筛查,要评估癌痛还需采用多维量表。无论选择何种评估工具,均强调对癌痛进行动态评估。简便易行的电子评估量表是目前癌痛新量表研制的趋势。      

静脉注射吗啡在重度癌痛治疗中的临床研究

目的观察静脉注射吗啡在重度癌痛治疗中的有效性及安全性。方法对48例住院的重度癌痛患者给予吗啡静脉注射,采用数字评价量表(numerical rating scale,NRS)每15分钟对疼痛程度进行评估,根据评分结果调整吗啡剂量,观察镇痛效果及不良反应。结果所有病例在注射三个周期后疼痛降至轻度疼痛或无痛,平均时间45分钟,未见明显的不良反应,24小时内癌痛控制有效率达到100%;在观察的时间内(24小时),不良反应有头晕(3例)、恶心、呕吐(5例),经对症治疗后缓解。结论静脉应用吗啡在重度癌痛的治疗中,能迅速缓解疼痛症状,降低NRS评分,提高患者生活质量,副反应少且可控制,是重度癌痛治疗的首选治疗方法。     

174例癌性疼痛患者使用吗啡针剂的临床观察

目的：观察并评估吗啡针剂对恶性肿瘤患者缓解癌性疼痛的作用。方法：选取2013年3月22日至2015年3月26日中国医学科学院肿瘤医院综合科病房收治的癌性疼痛并使用吗啡针剂的患者174例,观察并总结其临床资料及使用吗啡针剂的疗效。结果：单原发癌共165例,双原发癌共9例。患者入院时疼痛数字评分法（NRS）评分为（5.04±2.04）分,爆发痛（1.10±1.14）次/日;住院期间55例患者死亡,其余119例患者出院时 NRS 评分为（1.94±1.27）分,爆发痛（0.40±0.83）次/日;入院及出院时患者 NRS 评分及爆发痛次数比较,差异显著（P <0.05）。患者使用吗啡针剂前 NRS 评分为（7.23±1.78）分,吗啡针剂30min 后 NRS评分为（1.43±0.82）分,差异显著（P <0.05）。结论：吗啡针剂能够显著减轻患者癌性疼痛,改善患者生活质量。     

镇痛泵持续静脉泵注吗啡控制难治性癌痛的临床观察

目的评价镇痛泵静脉持续泵注吗啡治疗难治性癌痛的疗效及可行性。方法对2010年4月-2011年8月在本院应用镇痛泵静脉持续泵注吗啡控制癌痛的84例患者进行观察,评估首次疼痛缓解时间、疼痛强度的变化、疼痛缓解率和不良反应,记录治疗前后的数字分级法(numerical rating scale,NRS)评分并作比较。结果首次疼痛缓解时间平均为32 min;应用镇痛泵前后NRS评分的均值分别为7.57分和1.87分(P<0.001);全组病例的疼痛缓解率为91.7%;不良反应主要为便秘、恶心呕吐和尿潴留。结论镇痛泵静脉持续泵注吗啡控制难治性癌痛,其首次疼痛缓解时间短、NRS评分明显下降、疼痛缓解率高、不良反应小,是一种有效、安全、简便易行的治疗难治性癌痛的方法。     

疼痛对社区恶性肿瘤患者抑郁情绪及生活质量的影响

[目的]探讨疼痛对社区恶性肿瘤患者抑郁情绪及生活质量的影响。[方法]瑞安市社区1283例恶性肿瘤,采用Zung氏抑郁自评量表评价患者的抑郁情况,采用疼痛程度分级法（NRS）评估患者的疼痛程度。[结果]1283例肿瘤患者抑郁发生率为33.2%,中、重度癌痛发生率为43.6%。疼痛与患者的抑郁发生及生活质量有显著相关性。[结论]癌痛明显影响患者的生活质量和情绪,应积极实施三阶梯止痛原则,降低癌症患者抑郁的发生,提高患者的生活质量。     

盐酸羟考酮缓释片治疗胃癌患者中重度癌痛的临床疗效观察

目的：探讨盐酸羟考酮缓释片用于胃癌患者中重度癌痛的临床疗效和毒副反应。方法135例胃癌中重度癌痛患者均接受口服盐酸羟考酮缓释片控制癌痛,初始剂量10~20 mg/次,q12 h,用药过程中根据疼痛评估情况进行剂量调整,直至癌痛控制良好。2周后采取 NRS 评分法进行疼痛评分,并观察疼痛缓解情况、生活质量、药物毒副反应等。结果所有135例患者治疗后 NRS 评分为（1.68±0.98）分,明显低于治疗前的（7.22±2.13）分,差异有统计学意义（P ﹥0.05）。治疗后总疼痛缓解率为92.6％。生活质量改善率为74.1％。主要毒副反应为恶心呕吐、便秘、嗜睡等,均为轻度,未影响治疗的顺利进行。结论盐酸羟考酮缓释片用于胃癌患者能够良好控制中重度癌痛,明显改善患者的生活质量,且用药较为安全。     

催眠治疗改善癌症患者疼痛的临床研究和问卷调查

  目的  研究催眠疗法治疗癌痛的有效性,了解医护人员和患者对催眠疗法治疗癌痛临床应用的认知与需求。  方法  回顾性选取2020年1月至2020年12月于华中科技大学同济医学院附属同济医院招募罹患癌症且伴有疼痛的患者120例,进行8周的认知催眠治疗。比较癌痛患者接受催眠治疗2、4、8周后疼痛数字评分（NRS）、汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分及睡眠量表（MOS-SS）评分的变化;设计《催眠疗法治疗癌痛认知与需求调查问卷》,对2020年6月至2020年9月住院的354例癌痛患者和301名肿瘤科医护人员展开调查。  结果  120例癌痛患者参与了催眠治疗并完成了2周的评估,109例（90.8%）完成8周的治疗评估。催眠治疗2、4、8周后,NRS评分显著下降（P<0.05）;催眠治疗4、8周后,HAMA、HAMD评分显著下降（P<0.05）,MOS-SS评分显著升高（P<0.05）。84.1%的医护人员认为有必要常规开展认知催眠治疗;64.4%的癌痛患者能接受催眠治疗。  结论  催眠疗法可以减轻癌痛,同时降低癌痛患者的焦虑、抑郁情绪,改善患者睡眠状况;加强医护人员和患者的宣传教育对催眠疗法的临床应用具有重要意义。      

协同干预模式对直肠癌新辅助化疗患者营养状况、癌因性疲乏程度及生活质量的影响

目的探讨协同干预模式对直肠癌新辅助化疗患者营养状况、癌因性疲乏程度及生活质量的影响。方法依据干预方式将150例直肠癌新辅助化疗患者分为观察组和对照组,每组75例,对照组患者化疗过程中给予常规干预,观察组患者化疗过程中给予协同干预模式管理。干预前后,采用主观整体营养评估量表(PGSGA)和血清白蛋白水平评估两组患者的营养状况;采用癌因性疲乏量表评估两组患者的癌因性疲乏程度;采用生活质量量表(QOL)评估两组患者的生活质量。结果干预后,观察组患者PG-SGA评分明显低于本组干预前,两组患者癌因性疲乏量表评分均明显低于本组干预前,血清白蛋白水平和QOL量表各维度评分均明显高于本组干预前,且观察组患者PG-SGA评分、癌因性疲乏量表评分均明显低于对照组患者,血清白蛋白水平和QOL量表各维度评分均明显高于对照组患者,差异均有统计学意义(P﹤0.01)。结论协同干预模式可改善直肠癌新辅助化疗患者的营养状况及癌因性疲乏程度,提高患者化疗期间的生活质量。     

硫酸吗啡缓释片对中重度癌痛维持治疗的获益研究

目的:探讨硫酸吗啡缓释片对中重度癌痛维持治疗的效果,包括疗效、不良反应、费用、患者的依从性。方法:中重度癌痛患者,入院后数字评估法(NRS)动态疼痛评分,先用盐酸羟考酮缓释片与硫酸吗啡即释片滴定,患者阿片类药物耐受、疼痛评分3分以下及剂量相对稳定后,等剂量换算为硫酸吗啡缓释片口服,继续动态疼痛评分及药物剂量滴定。结果:等剂量硫酸吗啡缓释片对中重度癌痛维持治疗患者止痛效果更好,费用更低,患者依从性更好。结论:硫酸吗啡缓释片对于中重度癌痛的维持治疗能临床获益。     

心理干预对癌痛患者疗效及焦虑抑郁的影响

目的 观察心理干预联合止痛药物对癌痛患者治疗效果和焦虑抑郁的影响.方法 选取200例伴有疼痛的肿瘤患者,采用随机数字表法分为干预组和对照组,每组各100例.所有患者均进行癌痛规范化治疗,干预组在癌痛规范化治疗的基础上联合心理干预,4周后采用数字评分法(NRS)及医院焦虑抑郁量表(HAD)对患者的疼痛程度进行评定.结果 干预组患者治疗后的癌痛缓解率为92%,高于对照组的81%,差异有统计学意义(P﹤0.05);干预组患者治疗后的焦虑、抑郁评分低于对照组,差异均有统计学意义(P﹤0.05);干预组患者治疗后便秘的发生率为41%,明显低于对照组的62%,差异有统计学意义(P﹤0.01).结论 心理干预联合止痛药物可缓解癌痛程度,减轻患者的焦虑和抑郁,降低便秘的发生率.     

Efficacy of lamotrigine in the management of chemotherapy-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled trial, N01C3

BACKGROUND: Lamotrigine, an antiepileptic agent, has been reported as being effective in reducing symptoms of neuropathy associated with various etiologies. Based on such data, a multicenter double-blind, placebo-controlled, randomized trial was conducted to evaluate the effect of lamotrigine on pain and other neuropathic symptoms due to chemotherapy-induced peripheral neuropathy (CIPN). METHODS: Patients with symptomatic CIPN with symptom scores of either 1) >3 on a 0-10 Numerical Rating Scale (NRS) or 2) >1 on the 0-3 the Eastern Cooperative Oncology Group (ECOG) neuropathy scale (ENS) were eligible (higher numbers corresponding to greater severity of symptoms in both scales). Patients were randomly assigned to receive lamotrigine (target dose of 300 mg/day) or placebo for 10 weeks. Endpoints were measured biweekly. RESULTS: In all, 131 patients were enrolled. Both groups were well matched at baseline. Over the 10-week period of the trial, the average pain scores (NRS) for the lamotrigine and placebo arms declined in both arms, with no statistically significant difference noted between the changes in the 2 groups (0.3 and 0.5 unit reduction from baseline, respectively; P=.56). Similarly, decreases in the ENS with therapy were not statistically different (0.4 and 0.3, respectively; P=.3). Changes in other subjective symptom scales were also not found to be statistically different between the 2 groups. Toxicities were mild and similar in each group. CONCLUSIONS: The results suggest that lamotrigine is not effective for relieving neuropathic symptoms in patients because of CIPN.     

Efficacy of gabapentin in the management of chemotherapy-induced peripheral neuropathy: a phase 3 randomized, double-blind, placebo-controlled, crossover trial (N00C3)

BACKGROUND: The antiepileptic agent, gabapentin, has been demonstrated to relieve symptoms of peripheral neuropathy due to various etiologies. On the basis of these data, a multicenter, double-blind, placebo-controlled, crossover, randomized trial was conducted to evaluate the effect of gabapentin on symptoms of chemotherapy-induced peripheral neuropathy (CIPN). METHODS: Patients with symptomatic CIPN who complained of 'average' daily pain scores of either 1) >/=4 on a 0-10 numerical rating scale (NRS); or 2) >/=1 on the 0-3 Eastern Cooperative Oncology Group neuropathy scale (ENS) were eligible (higher numbers indicate greater severity of symptoms in both scales). Patients were randomized to receive gabapentin (target dose, 2700 mg) or placebo for 6 weeks. Crossover occurred after a 2-week washout period. CIPN-related symptoms were evaluated weekly by questionnaires. Statistical methods followed established methods for crossover designs, including Student t tests to compare average intrapatient differences between treatments and linear models to adjust for potential concomitant covariates. RESULTS: There were 115 patients who were randomly assigned to the treatment or control arm. Both groups were well matched by symptoms at study entry. Changes in symptom severity were statistically similar between the 2 groups during the study. Adverse events were mild and similar in both groups. CONCLUSIONS: This trial failed to demonstrate any benefit to using gabapentin to treat symptoms caused by CIPN.     

Assessing symptom burden using the M. D. Anderson symptom inventory in patients with chemotherapy-induced anemia: results of a multicenter, open-label study (SURPASS) of patients treated with darbepoetin-alpha at a dose of 200 microg every 2 weeks

BACKGROUND: Patients with cancer who are receiving chemotherapy often experience chemotherapy-induced anemia (CIA), which is associated with symptoms that reduce quality of life. The M. D. Anderson Symptom Inventory (MDASI) is a brief, self-rating assessment scale that measures the severity of core symptoms and symptom interference with function. The current study used the MDASI to prospectively assess the correlation between hemoglobin and self-perceived cancer-related symptoms in a large patient population with CIA who were receiving darbepoetin-alpha at a dose of 200 mug every 2 weeks. METHODS: Eligible patients enrolled in this multicenter, open-label study were age > or =18 years, had a nonmyeloid malignancy, were receiving multicycle chemotherapy, and were anemic (hemoglobin < or = 11 g/dL). Hemoglobin was measured every 2 weeks; the MDASI was administered weekly. For hemoglobin-based endpoints, patients were stratified by baseline hemoglobin (< 10 g/dL or > or =10 g/dL). RESULTS: Of 2422 enrolled patients, 2401 received > or =1 dose of darbepoetin-alpha. Eighty percent of patients (95% confidence limit, 78-82 patients) achieved target hemoglobin levels (> or =11 g/dL) during the study. Patients with a baseline hemoglobin < 10 g/dL had a greater increase in hemoglobin, took longer to achieve the target hemoglobin, and received more red blood cell transfusions than patients with a baseline hemoglobin > or =10 g/dL. The percentage of patients with moderate to severe MDASI scores (> or =5 points) for fatigue, distress, loss of appetite, disturbed sleep, and interference with function was reduced during the study. Improvement in symptom burden was associated with an increase in hemoglobin concentration. CONCLUSIONS: Treatment with darbepoetin-alpha at a dose of 200 mug every 2 weeks is associated with improvement in symptom burden as measured by the MDASI, a simple tool that may improve symptom management for cancer patients with CIA.     

晚期卵巢癌行热灌注化疗患者的生活质量现状分析

目的 调查晚期卵巢癌行热灌注化疗患者的生活质量。方法 采用一般资料调查问卷、生活质量核心问卷（QLQ-C30）、卵巢癌治疗功能评价量表（FACT-O）、自我感受负担量表（SPBS）、疼痛数字评价量表（NRS）及社会支持评定量表（SSRS）对本院300例晚期卵巢癌行热灌注化疗患者进行调查。结果 晚期卵巢癌行热灌注化疗患者QLQ-C30总分为（66.28±17.72）分，FACT-O 总分为（94.07±8.80）分，SPBS总分为（39.82±7.61）分；NRS评分为（5.68±1.24）分，SSRS得分为（23.96±6.57）分；Pearson相关分析结果显示，自我感受负担、社会支持和疼痛与生活质量相关（r=0.807,0.458,0.604）。结论 晚期卵巢癌行热灌注化疗患者的生活质量较差，自我感受负担、疼痛及社会支持可影响患者生活质量。     

营养风险筛查2002在老年恶性肿瘤患者化疗中的应用研究

目的:了解NRS2002在预估老年肿瘤患者化疗不良反应的潜在作用及相关影响因素,探讨潜在的化疗不良事件的干预措施。方法:2016年7月至2017年2月选择在我院肿瘤内科就诊的149例老年肿瘤化疗患者作为研究对象,入院24 h内完善NRS2002评分及相关病史采集,评估化疗不良反应分级。结果:149例患者中,有营养不良风险（NRS2002评分≥3分）的老年肿瘤患者占43.6%,无营养风险占56.4%,其中年龄、肿瘤类别分布、化疗不良反应分级、WBC、Hb、Scr、UA及血清K+组间差异有统计学意义（P<0.05）。相关性分析结果显示:不良反应分级与NRS2002评分呈正相关性,与WBC、Hb、SCr、UA及K+、Ca2+呈负相关性。线性回归分析提示NRS2002评分的高低与老年肿瘤患者化疗不良反应分级显著正相关,而SCr则是一个负性预测因子。结论:NRS2002可准确预估老年肿瘤化疗患者面临的潜在化疗风险,早期纠正贫血或可缩小老年肿瘤患者的化疗不良反应风险;肾功不全不再是化疗的绝对禁忌证。     

High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience

High-dose capsaicin patch is effective in treatment of neuropathic pain in HIV-associated neuropathy and diabetic neuropathy. There are no studies assessing effectiveness of high-dose capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy. We sought to determine the effectiveness of treatment of pain associated with chemotherapy-induced peripheral neuropathy with high-dose capsaicin patch. Our study group consisted of 18 patients with clinically confirmed oxaliplatin-induced neuropathy. Baseline characteristic including underling disease, received cumulative dose of neurotoxic agent, neuropathic symptoms, prior treatment and initial pain level were recorded. Pain was evaluated with Numeric Rating Scale prior to treatment with high-dose capsaicin and after 1.8 day and after 8 and 12 weeks after introducing treatment. Patients were divided into two groups accordingly to the amount of neurotoxic agent that caused neuropathy (high sensitivity and low sensitivity group). Most frequent symptoms of chemotherapy-induced neuropathy were: pain (88.89%), paresthesis (100%), sock and gloves sensation (100%) and hypoesthesis (100%). Initial pain level was 7.45 ± 1.14. Mean cumulative dose of oxaliplatin after which patients developed symptoms was 648.07 mg/m². Mean pain level after 12 weeks of treatment was 0.20 ± 0.41. When examined according to high and low sensitivity to neurotoxic agent patients with low sensitivity had higher pain reduction, especially after 8 days after introducing treatment (69.55 ± 12.09 vs. 49.40 ± 20.34%; p = 0.02) and after 12 weeks (96.96 ± 5.56 vs. 83.93 ± 18.59%; p = 0.04). High-dose capsaicin patch is an effective treatment for pain associated with chemotherapy-induced neuropathy in patients treated with oxaliplatin. Patients with lower sensitivity to neurotoxic agents have better response to treatment and pain reduction.     

Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy: North Central Cancer Treatment Group trial N08C1

BACKGROUND:

Paclitaxel causes an acute pain syndrome (P‐APS), occurring within days after each dose and usually abating within days. Paclitaxel also causes a more classic peripheral neuropathy, which steadily increases in severity with increasing paclitaxel total doses. Little detail is available regarding the natural history of these 2 syndromes, or any relationship between them, although a recent publication does provide natural history data about weekly paclitaxel, supporting an association between the severity of P‐APS and eventual peripheral neuropathy symptoms.

METHODS:

Patients entering this study were about to receive paclitaxel and carboplatin every 3 weeks. Daily questionnaires were completed for the first week after every chemotherapy dose, and European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Chemotherapy‐Induced Peripheral Neuropathy 20‐item instruments were completed weekly.

RESULTS:

The P‐APS severity peaked on day 4 after the initial chemotherapy dose, with 12%, 29%, 23%, and 36% of patients having maximal pain scores of 0, 1 to 4, 5 or 6, or 7 to 10 during the first week after the first dose of therapy, respectively. Patients with P‐APS scores of 0 to 4 with the first dose of chemotherapy had less eventual sensory neuropathy than did patients with P‐APS scores of 5 to 10 (P = 0.001). With regard to the more peripheral neuropathy, sensory neuropathy was more problematic than was either motor or autonomic neuropathy. Numbness and tingling were more common components of the sensory neuropathy than was pain.

CONCLUSIONS:

Patients with worse P‐APS severities appear to have more eventual chemotherapy‐induced peripheral neuropathy. This provides support for the concept that P‐APS is a form of nerve pathology. Cancer 2012. © 2012 American Cancer Society.     

Chemotherapy-Induced Neuropathy and Diabetes: A Scoping Review

Although cancer and diabetes are common diseases, the relationship between diabetes, neuropathy and the risk of developing peripheral sensory neuropathy while or after receiving chemotherapy is uncertain. In this review, we highlight the effects of chemotherapy on the onset or progression of neuropathy in diabetic patients. We searched the literature in Medline and Scopus, covering all entries until 31 January 2021. The inclusion and exclusion criteria were: (1) original article (2) full text published in English or Spanish; (3) neuropathy was specifically assessed (4) the authors separately analyzed the outcomes in diabetic patients. A total of 259 papers were retrieved. Finally, eight articles fulfilled the criteria, and four more articles were retrieved from the references of the selected articles. The analysis of the studies covered the information about neuropathy recorded in 768 cancer patients with diabetes and 5247 control cases (non-diabetic patients). The drugs investigated are chemotherapy drugs with high potential to induce neuropathy, such as platinum derivatives and taxanes, which are currently the mainstay of treatment of various cancers. The predisposing effect of co-morbid diabetes on chemotherapy-induced peripheral neuropathy depends on the type of symptoms and drug used, but manifest at any drug regimen dosage, although greater neuropathic signs are also observed at higher dosages in diabetic patients. The deleterious effects of chemotherapy on diabetic patients seem to last longer, since peripheral neuropathy persisted in a higher proportion of diabetic patients than non-diabetic patients for up to two years after treatment. Future studies investigating the risk of developing peripheral neuropathy in cancer patients with comorbid diabetes need to consider the duration of diabetes, cancer-induced neuropathic effects per se (prior chemotherapy administration), and the effects of previous cancer management strategies such as radiotherapy and surgery.     

Examining the Impact of a Web-Based Intervention to Promote Patient Activation in Chemotherapy-Induced Peripheral Neuropathy Assessment and Management

Lack of activation in self-care can compromise a patient’s ability to monitor and manage cancer treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN). The web-based Carevive® Care Planning System (CPS) was developed to promote evidence-based symptom assessment and treatment by enhancing patients’ involvement in their own care. The purpose of this single-arm, pre-test/post-test, prospective study was to examine whether the CPS can promote patient activation in CIPN symptom assessment and management. Seventy-five women with breast cancer receiving neurotoxic chemotherapy were recruited from a Comprehensive Cancer Center. Using standardized neuropathy measures embedded within the CPS, patients reported their CIPN symptoms over three consecutive clinical visits and completed the Patient Activation Measure (PAM) at the first and third visits. Mean changes in PAM scores between visits were compared using repeated measure analysis of covariance, adjusting for age. At baseline, patients were diagnosed with cancer within the past year (94.7%), highly activated (85% Level III/IV), and had a mean age of 51.3. PAM scores improved significantly from 67.15 (SD = 13.5; range = 47–100) at visit one to 69.29 (SD = 16.18; range = 47–100) (p = 0.02) (n = 62) at visit three. However, patients perceived the CPS to be of minimal value because it solely focused on CIPN and, for many, CIPN was not severe enough to motivate them to seek out symptom management information. Further research is needed to assess the utility of the CPS in promoting activation in the assessment and management of varying cancer treatment-related symptoms.     

乳腺癌术后辅助化疗患者营养风险状况及其对化疗不良反应的影响

 目的 观察乳腺癌术后辅助化疗患者的营养风险状况及其对化疗不良反应的影响。方法 选取营养风险筛查量表2002（nutritional risk screening 2002,NRS 2002）评分＜3分的乳腺癌术后患者96例,化疗6个周期后再次评估,根据NRS 2002评分,≥3分为营养风险组,＜3分为无营养风险组,分析两组临床资料、营养风险状况、不良反应及住院天数。结果 96例乳腺癌患者术后辅助化疗6个周期后,NRS 2002评分≥3分者39例,营养风险发生率为40.6%;两组患者月经情况、雌激素受体/孕激素受体（ER/PR）、人表皮生长因子受体2（cerbB-2）、细胞增殖指数（Ki-67）、临床分期、化疗药物相对剂量强度等临床资料比较,差异均无统计学意义（P均＞0.05）。两组化疗前后血红蛋白、血白蛋白、总淋巴细胞计数、肱三头肌皮褶厚度等营养指标的差异均无统计学意义（P均＞0.05）;营养风险组体重指数（BMI）化疗前后比较差异有统计学意义（P＜0.05）,无营养风险组BMI化疗前后比较差异无统计学意义（P＞0.05）,化疗后两组BMI比较差异有统计学意义（P＜0.05）。营养风险组Ⅲ级/Ⅳ级主要不良反应为中性粒细胞减少、血红蛋白减少、血小板减少、恶心呕吐、口腔黏膜炎、肝功能异常、疲乏等,其发生率及住院时间均高于无营养风险组（P均＜0.05）。 结论 乳腺癌术后辅助化疗期的患者存在较高的营养风险发生率,及早评估和发现其营养风险,有助于预测患者的化疗风险,减少化疗不良反应的发生。