胃肠道肿瘤术后辅助化疗病人营养不良现状调查与分析

目的 :通过对胃肠道肿瘤术后辅助化疗病人进行营养风险筛查,调查营养不良的发生率并进行原因分析,为该类病人临床营养干预治疗提供依据。方法 :自2016年7月至12月对入住普通外科胃肠肿瘤术后并行辅助化疗的181例病人,运用PG-SGA进行营养风险筛查,同时检测血清白蛋白、血红蛋白和白细胞,记录病人化疗期间的不良反应。根据性别、年龄、不同肿瘤部位、化疗疗程、症状等进行不同分值的亚组分析。结果 :所有181例病人均完成营养风险筛查,其中PG-SGA得分在0~3分的69例(占38.1%),4~8分即中度营养不良的71例(占39.2%);大于8分即存在严重营养不良的41例(占22.7%),4分以上即存在营养不良的共112例占61.9%。对112例营养不良病人进一步分析:胃癌病人PG-SGA得分明显高于直肠癌病人(P0.05)和结肠癌病人(P0.01);男性发生率高于女性(P0.05);年龄大于65岁的营养不良发生率高于65岁以下病人(P0.01)。PG-SGA得分越高化疗药物引起的恶心、呕吐等毒副反应越重,血红蛋白、白细胞水平也越低(P0.01)。营养不良与病人化疗疗程无统计学差异。结论 :胃肠道肿瘤术后辅助化疗病人营养不良发生率高,肿瘤部位、性别、年龄和化疗不良反应等是高危因素。

Investigation and analysis of malnutrition after adjuvant chemotherapy in patients with gastrointestinal tumor

Objective:This study aims to investigate the incidence and potential cause of the undernutrition in gastrointestinal cancer patients received postoperatively adjuvant chemotherapy.Method:Between July and December 2016,a total of 181 gastrointestinal cancer patients who underwent postoperatively adjuvant chemotherapy in the Department of General Surgery of Nanjing General Hospital were enrolled in this study.Nutritional risks of the patients were screened by the patient-generated subjective global assessment (PG-SGA).Serum albumin concentrations,plasma hemoglobin levels and white blood cell numbers of the patients were determined during the chemotherapy.The patients'clinical data,including gender,age,tumor location,chemotherapy stage and adverse events post the chemotherapy,were recorded.Result:All patients completed the PG-SGA for nutritional risk screening.Among the patients,69 cases (38.1％) had a PG-SGA score of 0 ～ 3 points,showing absence of undernutrition.The remaining 112 cases (61.9％)had a PG-SGA score above 4 points,indicating moderate or severe undernutrition.71cases (39.2％) of them displayed moderate underuutrition (4-8 points),and 41 cases (22.7 ％) showing severe undernutrition (＞ 8 points).The PG-SGA scores in patients with gastric cancer were significantly higher than those in the rectal cancer patients (P ＜ 0.05) and in the colon cancer cases (P ＜ 0.01).In addition,the incidence of undernutrition in the male patients was much higher than in the female cases (P ＜ 0.05).The incidence of undernutrition in the patients aging ＞ 65 years was higher than in the cases below 65 years old (P ＜ 0.05).The levels of plasma hemoglobin and numbers of white blood cells were significantly lower in the patients with undernutrition (PG-SGA score ＞4 points),and adverse events such as nausea and vomiting were also more frequently presented in these cases.No significant difference in the incidence of the patients' undernutrition was observed between different stages of the chemotherapy.Conclusion:The patients with gastrointestinal cancer underwent postoperatively adjuvant chemotherapy had higher incidence ofundernutrition.Gender,age and tumor location were the risk factors for the development of undernutrition.Our findings provide evidence for the utilization of nutrition interventions in these patients.