老年喉癌患者围手术期营养评价与护理对策

Perioperative assessment of the nutritional status and nursing strategies on nutritional support in the aged patients with laryngeal cancer

目的评价老年喉癌患者在围手术期的营养状况,探索改善老年喉癌患者营养状况的护理对策。方法选择2006年7月至2008年6月,65例60-82岁拟行部分或全喉切除术的喉癌住院患者,在围手术期使用体质指数(BMI)、营养状况综合评价法(SNA)对65例患者在术前1d,术后3、7、14d进行营养评估。结果老年喉癌患者手术前营养不良率10.8%,实验室检查结果营养不良率7.7%-50.8%;手术后营养不良加重;与手术前相比较,患者手术后体BMI明显下降(P<0.001);体重、前白蛋白、白蛋白、淋巴细胞总数、运铁蛋白、上臂肌围值明显下降(P<0.05-0.001)。结论老年喉癌患者围手术期营养不良发生率高,部分或全喉切除手术后营养不良显著加重,肠内和肠外联合营养支持不能迅速完全纠正,在老年喉癌患者围手术期进行简单的营养评估和有针对性的饮食护理指导非常重要。

Objective To assess the perioperative nutritional status and explore nursing strategies of nutritional support in aged patients with laryngeal cancer. Methods The nutritional status of 65 patients aged between 60 to 82 with total or partial laryngectomy was assessed by Body Mass Index （BMI）and Subjective Nutritional Assessment （SNA）at the time of the day before surgery and the third ,seventh,fourteenth postoperative days. Results The incidence of malnutrition during preoperative period was 10.8% by BMI and 7.7%-50.8% by laboratory parameters. Compared with the preoperative period,the postoperative BMI as well as the body weight （BW）, prealbumin （PA）, albumin levels （ALB）, total lymph cell account （TLC）, transferrin （TF）, and arm muscle circumference（AMC）decreased significantly（P〈0.05）. Conclusion The prevalence of perioperative malnutrition in aged patients with laryngeal cancer is high. It significantly worsened during the postoperative period even if all patients were given nutritional support. Nurses should make a simple nutritional assessment,provide both essential nutritional support and diet instructions during perioperative period for the aged patients with laryngeal cancer.