营养状况对胃癌术后化疗耐受性及负性情绪的影响

Effects of nutritional status on postoperative chemotherapy tolerance and negative emotion in patients with gastric cancer

目的:探讨营养状况对恶性肿瘤病人术后化疗的耐受性及负性情绪影响。方法:纳入 2015年 7月~ 2017年 4月在我院行胃癌根治术后辅助化疗的病人,共计 78例。依据化疗前营养状况分为营养不良组(n = 40)和无营养不良组(n = 38)。观察两组化疗期间不良反应发生情况,采用正性负性情绪量表(PANAS)评估两组病人化疗前后负性情绪情况,统计因严重不良反应或负性情绪而停止化疗的病人比例。结果:化疗期间,营养不良组出现消化系统反应(食欲减退、恶心呕吐)及骨髓抑制反应(白细胞降低、血小板降低及红细胞降低)的比例均显著高于无营养不良组(P < 0.05)。两组病人化疗前 PANAS评分无统计学差异(P > 0.05)。最后一次化疗时,两组病人PANAS评分均显著高于本组化疗前(P < 0.01),但营养不良组病人高于无营养不良组病人(P < 0.01)。化疗期间,营养不良组病人共计有 13例因不耐受化疗而终止化疗,无营养不良组有 5例。营养不良组病人终止化疗比例显著高于无营养不良组病人[(32.5%,13/40) vs (13.2%,5/38),P = 0.032]。结论:营养不良的病人在术后行辅助化疗中更易出现不易耐受现象,且较营养正常病患更易产生负性情绪。

Objective: To explore the effects of nutritional status on postoperative chemotherapy tolerance and negative emotion in patients with gastric cancer. Methods: A total of 78 patients with adjuvant chemotherapy after radical gastrectomy in our hospital from July 2015 to April 2017 were included. According to the nutritional status before chemotherapy, they were divided into malnutrition group (n = 40) or no malnutrition group (n = 38). The incidence of adverse events during the periods receiving chemotherapy was observed. The positive negative emotion scale (PANAS) was used to evaluate the negative emotions of the two groups before and after chemotherapy, and the proportion of patients who stopped chemotherapy due to serious adverse events or negative emotions was also collected. Results: During the periods receiving chemotherapy, the proportion of digestive system adverse events (appetite loss, nausea and vomiting) and myelosuppressive responses (leukopenia, thrombocytopenia, and red blood cell reduction) in the malnutrition group were significantly higher than those in the no malnutrition group (P < 0.05). There was no significant difference in PANAS scores between the two groups before chemotherapy (P > 0.05). At the last chemotherapy, the PANAS scores of the two groups were significantly higher than those before chemotherapy (P < 0.01), but the scores of patients in the malnutrition group were higher than those of the no malnutrition group (P<0.01). During chemotherapy, a total of 13 patients in the malnutrition group discontinued chemotherapy due to intolerance to chemotherapy, and 5 patients in the no malnutrition group. The proportion of patients receiving chemotherapy in the malnutrition group was significantly higher than that in the no malnutrition group ([32.5%, 13/40] vs [13.2%, 5/38], P=0.032). Conclusion: Malnourished patients are more prone to intolerant of postoperative adjuvant chemotherapy, and are more likely to develop negative emotions than patients with normal nutrition.