食管癌放疗患者营养不良风险和营养状况分析

Analysis of risks of malnutrition and nutritional status of patients with esophageal cancer receiving radiotherapy

目的：评价食管癌患者放疗期间的营养不良风险和营养状况，探索改善食管癌患者营养状况的护理对策。方法选择2012年6月-2013年4月60例行放疗的食管癌住院患者，运用人体测量指标、实验室检查数据对患者在入院时、放疗当日、放疗后每周进行营养评估，运用欧洲营养风险筛查工具（ NRS2002）每周对患者进行营养风险筛查。结果 NRS 2002营养筛查工具评分显示食管癌患者放疗开始后营养不良风险数值逐步增加，放疗2周后评分为（2．06±177;1．22），与放疗前比较差异有统计学意义（t＝-2．457，P＜0．05）；放疗2周后体质指数（20．21±177;2．69）kg／m2、三头肌皮褶厚度（7．27±177;3．20）mm、上臂围（24．71±177;2．68）cm、总蛋白（65．50±177;5．25）g／L、白蛋白（38．48±177;5．00）g／L、淋巴细胞总数（6．55±177;3．42）±215;109／L，与入院时比较差异有统计学意义（ t值分别为3．204，2．777，3．053，7．174，5．685，12．508；P＜0．05），并在后续每周评分中各指标仍呈逐渐下降趋势；放疗2周后营养不良发生率增加，以TSF、TP、TLC进行评价时，分别为95．00％，11．67％，98．33％，与入院时比较差异有统计学意义（χ2值分别为11．800，7．792，73．024；P＜0．05）。结论食管癌患者放疗期间营养不良风险逐步增加，营养状况逐渐下降，放疗2周后营养不良发生率增加。

Objective To evaluate the risks of malnutrition and nutritional status of patients with esophageal cancer during radiotherapy , so as to explore nursing countermeasures to improve their nutritional status.Methods 60 inpatients with esophageal cancer receiving routine radiotherapy from June 2012 to April 2013 were investigated with anthropometric indicators and laboratory data for weekly nutritional evaluation on admission, during radiotherapy, and after radiotherapy.Meanwhile, the patients were conducted with Nutritional Risk Screening （ NRS2002 ） per week .Results NRS2002 score showed that the malnutrition risk values of patients with esophageal cancer gradually increased after radiotherapy .The score was （2.06 ±177;1.22） after 2 weeks of radiotherapy, suggesting that the difference was statistically significant （t=-2.457, P＆lt;0.05）. After the radiotherapy , the scores of body mass index （ BMI ） , triceps skinfold （ TSF ） , arm circumference （AC）, total protein （TP）, albumin （ALB） and total lymphocyte count （TLC） were （20.21 ±177;2.69）kg/m2, （7.27 ±177;3.20）mm, （24.71 ±177;2.68）cm, （65.50 ±177;5.25）g/L, （38.48 ±177;5.00）g/L and （6.55 ±177;3.42） ±215; 109/L, respectively, compared with those of admission , they decreased gradually in the subsequent weekly examinations and had statistical significance （ t=3.204,2.777, 3.053,7.174,5.685,12.508, respectively;P＆lt;0.05）.After 2 weeks of radiotherapy, the incidence of malnutrition increased compared to that of admission, and the scores of TSF, TP and TLC were 95.00%, 11.67% and 98.33% respectively, which showed the statistically significant difference （χ2 =11.800, 7.792, 73.024, respectively; P ＆lt;0.05 ）. Conclusions Patients with esophageal cancer gradually have higher risk of malnutrition and worse nutritional status during radiotherapy and their incidence of malnutrition increased after 2 weeks of radiotherapy .