【作者】 刘丹丹；

【导师】 刘娅；

【作者基本信息】 吉林大学 ， 公共卫生硕士（专业学位）， 2016， 硕士

【摘要】 目的:本研究运用患者主观整体评价的调查问卷对胃肠道恶性肿瘤患者的营养状态及营养支持情况进行分析。方法:选取2015年5月至2016年6月期间在吉林省长春市吉林大学第一医院就诊的1019例胃肠道恶性肿瘤患者,患者的基本健康资料利用医院病历系统获取,应用患者主观整体评价调查问卷对患者的6项营养现状进行评估,具体内容包括:摄食状况、活动、患者体格检查、实验室检查指标、营养支持情况以及随访患者于本次调查后30天内的生存或死亡情况。调查和评估结果录入至数据库中,应用SPSS20.0进行相关统计分析。结果:1.本研究共纳入1019例胃肠道恶性肿瘤患者(男性653例,女性366例)。经PG-SGA营养状况调查表评估可知:营养良好者332例(构成比为32.58%),轻/中度营养不良者547例(构成比为53.68%),重度营养不良者140例(构成比为13.74%)。。2.本研究根据患者年龄将其分为非老年组((27)60岁)和老年组(≥60岁),老年组患者营养不良发生率(83.30%)高于非老年组患者(53.33%)。3.吸烟和饮酒均可导致患者营养不良的发生(p<0.05)。4.家族肿瘤史对营养不良的发生有影响(p<0.01)。5.肿瘤病灶转移、肿瘤分期能影响患者营养不良的发生(p<0.01)。6.患者所接受的放、化疗治疗方法和患者的活动能力均对患者营养情况有影响(p<0.01)。7.经PG-SGA定性评价并进行统计学分析,随着患者营养不良情况加剧,其单一营养指标逐渐下降(p<0.05)。结论:1.患者的年龄、吸烟与饮酒习惯、家族疾病史、病灶转移情况、肿瘤分期、放化疗治疗方法和患者的活动能力都可能对患者的营养状况产生影响。2..经PG-SGA评估随着患者营养状况的恶化,临床常用营养指标(Alb、Hb、BMI、MAC、TSF、非利手握力、小腿最大周径等)会表现为逐渐升高的趋势,并且营养良好和营养不良患者间差异具有统计学意义。3.患者出现营养不良会影响其接受的营养支持方式、延长住院时间、降低患者生活质量等。4.可应用PG-SGA问卷及时对胃肠道恶性肿瘤患者营养状况进行评价,并且根据PG-SGA总得分为患者制定合理的营养支持方案。通过多角度、多种手段联合治疗改善患者营养现况及预后。更多还原

【Abstract】 Objective:Using Patient-Generated Subjective Global Assessment(PG-SGA) to investigate the nutritional status and nutriention support of patients with gastrointestinal tumors in the First Hospital of Ji Lin University.Descirbe the nutritional status of patients with gastrointestinal tumors and compare the dangerous factors which may cause malnutrition of patients.Methods:According to fixed point continuous sampling, 1019 gastrointestinal tumor patients who match the inclusion criteria from the Tumor Therapy Cneter of the First Hospital of Ji Lin University were recruited from May 2015 to June 2016. Patients’ basic information data were collected from the electronic medical record system in the hospital.Using PG-SGA to do the nutrition estimation for the patients, thoroughly evaluated patients’ nutritional therapy and sustentation after admitted to hospital.All patients who be selected were accepted somatoscopy,biochemistry test(including: Body mass index, weight, triceps skinfold thickness, upper arm midpoint circumference, the upper arm muscle circumference).The patients were seen for follow-up 30 days after the survey to investigate their surviving state. Excel was used for data entry and SPSS20.0 for data analysis. The nutritional status of patients was evaluated by PG-SGA scale. According to the result, patients’ nutritional status could graded into good nutrition(PG-SGA≤ 1 points or PG-SGA quantitative assessment level A), Mild/moderate malnutrition(PG-SGA score between 2~8 or PG-SGA qualitative assessment level B) and Severe malnutrition(PG-SGA ≥9 or PG-SGA quantitative assessment level C).Results:1. There are a total of 1019 patients(653 males and 366 females) with gastrointestinal cancer included in the database. Assessed by Patient-Generated Subjective Global Assessment(PG-SGA), there are 332 objects in good nutrition, 547 objects with mild or moderate malnutrition, while 140 objects with severe malnutrition.2. According to age, the patients were divided into non-elderly group(< 60yrs) and elderly group(≥60 yrs), and there was a statistically significant difference.3. Smoking and drinking significantly affect the nutritional status of patients(p< 0.05).4. There was statistically significant that studying on whether there was a statistically significant difference in the incidence of malnutrition, among patients with family history of cancer(p< 0.05).5. The different of malnutrition incidence of patients with tumor metastasis or different tumor stage was statistically significant(p< 0.05).6. The radiotherapy, chemotherapy and the capacity for action of patients with tumor had significant effct on patients’ nutritionalstatus(p< 0.05).7. The variance analysis showed that the expression of a single nutrient index gradually decreased with the aggravation of malnutrition(qualitative evaluation by PG-SGA) and the difference was statistically significant(p< 0.05)while the linear correlation analysis suggested that the PG-SGA score(qualitative evaluation by PG-SGA) was negatively correlated with the single nutrient indicators and the difference was also statistically significant(p< 0.05).Conclusion:1. Which can affect the nutritional status of the patients with gastrointestinal cancer is including age, smoking, alcohol drinking, tumor metastatic, the treatment of radiotherapy or chemotherapy. In addition, patients with malnutrition will affect the duration of hospitalization, mid-arm muscle circumference, triceps skin fold, maximum circumference of calf, serum albumin, hemoglobin and the quality of life.2. PG-SGA questionnaire is significant correlated with the single nutrient indicators as well as the Alb,Hb,MAC and so on. And it is good applicability for evaluation of nutritional status of the patients with gastrointestinal cancer.3. The occurrence of malnutrition in patients with gastrointestinal cancer is high, and the nutritional support has influence on the recent clinical outcomes of the patients. The nutritional status of patients with gastrointestinal cancer should be evaluated in time, in order to establish a reasonable nutritional support program to improve the nutritional status and prognosis of patients.更多还原