适应黏稠度的营养摄入方法对喉癌术后放疗后吞咽障碍患者营养状况的影响

Effect of nutrition intake method with adaptive viscosity on nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy

目的探讨适应黏稠度的营养摄入方法对喉癌术后放疗后吞咽障碍患者营养状况的影响。方法 77例喉癌术后放疗后存在吞咽功能障碍的患者随机分为2组:研究组(39例)和对照组(38例)。对照组接受吞咽功能训练和常规饮食健康指导,研究组在这基础上接受适应性黏稠度的口服营养补充,分析比较2组患者在放疗结束时、放疗后3个月的体质量、身体质量指数、血红蛋白、白蛋白、前白蛋白水平和营养状况评分,同时记录3个月期间患者的肺部感染率。结果在放疗结束时两组营养状况评分≥2分的患者分别为34例(87.2%)和32例(84.2%)。放疗后3个月,研究组的平均体质量、身体质量指数、血红蛋白、白蛋白、前白蛋白含量、每日摄入量和营养状况评分均优于放疗结束时及对照组[(61.28±11.16) vs.(51.82±7.36)、(56.44±10.69)kg,P=0.000、0.033;(20.57±6.13) vs.(18.81±4.43)、(19.47±5.36)kg/m^2,P=0.001、0.047;(134.87±17.86) vs.(114.68±15.25)、(123.58±19.34)g/L,P=0.001、0.037;(40.74±7.54) vs.(36.77±5.27)、(37.94±8.47)g/L,P=0.000、0.016;(312.83±35.83) vs.(271.56±32.82)、(290.73±41.38)g/L,P=0.000、0.02;(2 047±126) vs.(1 512±143)、(1 589±138)kcal, P=0.000、0.000;(2.36±0.93) vs.(3.70±1.80)、(3.14±1.26)分,P=0.000、0.002],对照组的平均体质量和血红蛋白含量高于其放疗结束时[(56.44±10.69) vs.(51.56±8.34)kg,P=0.025;(123.58±19.34) vs.(113.36±16.56)g/L, P=0.023]。3个月期间,2组患者的肺部感染率分别为1例(2.5%)和6例(15.8%),研究组明显低于对照组(χ^2=4.073,P=0.044)。结论适应黏稠度的营养摄入方法可以更有效改善喉癌术后放疗后吞咽障碍患者的营养状况,降低肺部感染率。

Objective To investigate the effect of nutrition intake method with adaptive viscosity on nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy (RT). Methods 77 laryngeal carcinoma patients with dysphagia after surgery and radiotherapy were divided randomly into two groups by a random number table as study group (SG, n=39) and control group (CG, n=38). The CG received routine diet instruction and swallowing training, while the SG received oral nutritional supplementation with adaptive viscosity in additon. The body weight, body mass index (BMI), hemoglobin, albumin, prealbumin and scores of nutritional status at the end and 3 months after RT were compared between the two groups. Results There were 34 patients (87.2%) and 32 patients (84.2%) with nutritional status scores more than or equal to 2 at the end of RT in the two groups. At 3 months after RT, the body weight, BMI, hemoglobin, albumin, prealbumin, daily intake and nutritional status scores in the study group were significantly higher than those at the end of RT and those in the control group [(61.28±11.16) vs.(51.82±7.36),(56.44±10.69)kg;(20.57±6.13) vs.(18.81±4.43),(19.47±5.36)kg/m2;(134.87±17.86) vs.(114.68±15.25),(123.58±19.34)g/L;(40.74±7.54) vs.(36.77±5.27),(37.94±8.47)g/L;(312.83±35.83) vs.(271.56±32.82),(290.73±41.38)g/L;(2 047±126) vs.(1 512±143),(1 589±138)kcal;(2.36±0.93) vs.(3.70±1.80),(3.14±1.26);P all<0.05]. The level of the body weight and hemoglobin in the control group at 3 months after RT were significantly higher than those at end of RT [(56.44±10.69) vs.(51.56±8.34)kg, P=0.025;(123.58±19.34) vs.(113.36±16.56)g/L, P=0.023]. During 3 months, the rate of pulmonary infection was 1 (2.5%) in the study group and 6 (15.8%) in the control group and the difference was statistically significant (χ^2=4.073, P=0.044). Conclusion Nutrition intake method with adaptive viscosity can effectively improve the nutritional status of laryngeal cancer patients with dysphagia after surgery and radiotherapy and reduce the infection rate of lung.