连续性护理干预在老年进展期胃癌患者新辅助化疗联合肠内营养支持中的应用

Application of continuous nursing intervention in neoadjuvant chemotherapy combined with enteral nutrition support in elderly patients with advanced gastric cancer

目的探究连续性护理干预在进展期胃癌老年患者新辅助化疗联合肠内营养支持中的应用效果。方法选取2017年9月~2019年月9在我院住院的90例进展期胃癌老年患者,用随机数字表法将其分为干预组和对照组,每组各45例。两组入院后均执行胃癌护理常规,干预组在此基础上实施连续性护理干预。比较两组的营养状况、化疗不良反应及生活质量。结果干预前,两组的各项营养指标比较,差异无统计学意义(P>0.05);干预后干预组的营养指标[(清蛋白、前清蛋白、血常规淋巴细胞计数及体重指数(BMI)]高于对照组,差异有统计学意义(P<0.05)。干预组干预前后的营养指标比较,差异无统计学意义(P>0.05)。对照组干预后清蛋白明显低于干预前,差异有统计学意义(P<0.05)。对照组干预后其他营养指标与干预前比较,差异无统计学意义(P>0.05)。干预组的恶心呕吐、肝肾功能异常程度轻于对照组,差异有统计学意义(P<0.05)。两组的腹泻、骨髓抑制程度比较,差异无统计学意义(P>0.05)。干预前两组的生活质量各维度评分比较,差异无统计学意义(P>0.05);干预组干预后的躯体功能、角色功能、社会功能及总体健康状况评分高于干预前,差异均有统计学意义(P<0.05);干预组干预前后的情绪功能及认知功能评分比较,差异无统计学意义(P>0.05)。干预组干预后的恶心、呕吐、疼痛及腹泻评分低于干预前,差异有统计学意义(P<0.05);干预组干预前后的疲劳、气短、失眠、食欲缺乏、便秘及经济困难评分比较,差异无统计学意义(P>0.05)。对照组干预后的角色功能评分高于干预前,差异有统计学意义(P<0.05);对照组干预前后的躯体功能、情绪功能、认知功能、社会功能及总体健康状况评分比较,差异无统计学意义(P>0.05)。对照组干预前后的疲乏、恶心、呕吐、疼痛、气短、失眠、食欲缺乏、便秘、腹泻及经济困难评分比较,差异无统计学意义(P>0.05)。实施连续性护理干预后,干预组的躯体功能、角色功能、认知功能、情绪功能及社会功能5个功能领域子量表及总体健康状况评分高于对照组,差异均有统计学意义(P<0.05)。干预后干预组的疲劳、恶心及呕吐、疼痛及气短、失眠、食欲缺乏、便秘、腹泻、经济困难评分低于对照组,差异均有统计学意义(P<0.05)。结论连续性护理干预可有效提高进展期胃癌老年患者的营养状况,降低新辅助化疗的不良发应,改善患者生活质量,值得推广。

Objective To explore the effect of continuous nursing intervention in neoadjuvant chemotherapy combined with enteral nutrition support in elderly patients with advanced gastric cancer.Methods A total of 90 elderly patients with advanced gastric cancer who were hospitalized in our hospital from September 2017 to September 2019 were selected.The patients were divided into intervention group and control group using random number table method,45 cases in each group.Patients in both groups received conventional gastric cancer nursing after admission,and in the intervention group,continuous nursing intervention was added.The nutritional status,adverse reactions of chemotherapy and quality of life(QOL)of the two groups were compared.Results Before the intervention,there were no statistical differences in nutritional indicators between the two groups(P>0.05).After the intervention,the nutritional indicators including albumin,prealbumin,blood lymphocyte count and body mass index(BMI)of the intervention group were higher than those of the control group,and the differences were statistically significant(P<0.05).In the intervention group,there were no significant differences in nutritional indicators before and after the intervention(P>0.05).In the control group, the prealbumin after the intervention was much lower than that before the intervention (P<0.05). In the control group, for other indicators, there were no significant differences between post-intervention and prior intervention (P>0.05). The degree of nausea, vomiting, liver and kidney function abnormalities in the intervention group were greatly milder compared with those in the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the degree of diarrhea and bone marrow suppression between the two groups (P>0.05). Before intervention, there was no significant difference in each dimension of the QOL scores between the two groups (P>0.05). In the intervention group, the scores of physical function, role function, social function, and overall health status after the intervention were higher than those before the intervention, with statistical differences (P<0.05). In the intervention group, emotional function and cognitive function scores before and after the intervention did not display statistical significance (P>0.05). In the intervention group, the scores of nausea, vomiting, pain and diarrhea after the intervention were all lower than those before the intervention (P<0.05). In the intervention group, the scores of fatigue, shortness of breath, insomnia, lack of appetite, constipation and financial difficulties before and after intervention did not differ statistically (P>0.05). In the control group, the role function score after the intervention was higher than that before the intervention, and the difference was statistically significant (P<0.05). In the control group, there were no statistical differences in the scores of physical function, emotional function, cognitive function, social function, or overall health before and after the intervention (P>0.05). In the control group, the scores of fatigue, nausea, vomiting, pain, shortness of breath, insomnia, lack of appetite, constipation, diarrhea and financial difficulties before and after the intervention were not statistically different (P>0.05). After the implementation of continuous nursing intervention, the five functional aspects of physical function, role function, cognitive function, emotional function and social function of the intervention group and the overall health score in the intervention group were all higher than those of the control group, and the differences were statistically significant (P<0.05). After the intervention, the scores of fatigue, nausea and vomiting, pain and shortness of breath, insomnia, lack of appetite, constipation, diarrhea, and financial difficulties in the intervention group were lower than those in the control group, and the differences were statistically significant (P<0.05). Conclusion Continuous nursing intervention can effectively improve the nutritional status of elderly patients with advanced gastric cancer, reduce the adverse reactions of neoadjuvant chemotherapy, and ameliorate patient′s QOL, which is worthy of further exploration and promotion.