不同运动强度对食管癌患者同步放化疗期间营养状况和疲乏程度的影响

Effects of different levels of exercise intensity on nutritional status and fatigue in patients with esophageal cancer during concurrent chemoradiotherapy

目的分析不同步行运动强度在食管癌患者同步放化疗期间的应用效果。方法采用便利抽样法, 选取2019年4月至2020年10月湖北文理学院附属医院襄阳市中心医院收治的食管癌放化疗患者120例, 按照随机数字表法分为对照组、低运动量组、中运动量组和高运动量组, 每组30例。研究过程中, 共剔除8例, 其中低运动量组2例(中断治疗失访), 中运动量组1例(未完成目标运动量), 高运动量组3例(1例失访, 2例未完成目标运动量), 对照组2例(1例失访, 1例运动量超过5 000步/d), 最终纳入112例。所有患者均给予常规放化疗护理, 在此基础上, 平均每日步行量低运动量组为5 000 ~ 7 499步/d, 中运动量组为7 500 ~ 9 999步/d, 高运动量组为10 000 ~ 12 499步/d, 对照组对步行量不做要求, 但<5 000步/d。治疗前和放化疗第3、6周, 采用患者主观整体营养状况评估量表(PG-SGA)、BMI、血清总蛋白、白蛋白和Piper疲乏修订量表(PFS-R)评价疗效。结果放化疗第6周, 中运动量组和高运动量组PG-SGA得分分别为(4.31 ± 1.47)分和(4.15 ± 1.46)分, 低于低运动量组和对照组的(5.46 ± 1.88)分和(5.96 ± 1.91)分, 差异有统计学意义(t值为2.57 ~ 3.98, 均P<0.05);放化疗第6周时, 中运动量组和高运动量组的血清总蛋白和白蛋白分别为(54.45 ± 10.58)、(33.72 ± 7.19)g/L和(55.19 ± 9.82)、(34.00 ± 6.52)g/L, 高于低运动量组和对照组的(49.11 ± 7.71)、(29.61 ± 6.21)g/L和(48.04 ± 8.40)、(30.04 ± 6.13)g/L, 差异有统计学意义(t值为2.19 ~ 2.88, 均P<0.05)。放化疗第3、6周, 中运动量组PFS-R得分为(3.41 ± 0.57)、(4.62 ± 0.73)分, 低于低运动量组、高运动量组和对照组的(4.25 ± 0.89)、(5.43 ± 0.69)分, (4.19 ± 0.79)、(6.11 ± 0.93)分和(4.14 ± 0.59)、(5.39 ± 0.79)分, 差异有统计学意义(t值为4.01 ~ 8.63, 均P<0.05)。结论 7 500 ~ 9 999步/d是同步放化疗食管癌患者最佳步行运动量, 可有效改善患者营养状况和减轻疲乏感。

Objective To analyze applications of different level of exercise intensity in patients with esophageal cancer during concurrent chemoradiotherapy.Methods By convenient sampling method,a total of 120 patients with esophageal cancer during concurrent chemoradiotherapy were adopted in Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Sciences from April 2019 to October 2020,they were assigned to control group,primary degree group,intermediate degree group and advanced degree group according to the random number table method,with 30 patients in each group.All patients were given routine concurrent chemoradiotherapy nursing care,based on this,the primary degree group average walk were 5000-7499 steps/d,intermediate degree group were 7500-9999 steps/d,advanced degree group were 10000-12499 steps/d,besides,the control group did not require the amount of walking.Before and three,six weeks after therapy,the intervention effect was assessed by Scored Patient-Generated Subjective Global Assessment(PG-SGA),BMI,serum total protein,albumin as well as the Revised Piper Fatigue Scale(PFS-R).Results After six months of therapy,the scores of PG-SGA were(4.31±1.47)and(4.15±1.46)in the intermediate degree group and advanced degree group,lower than in the primary degree group and control group(5.46±1.88)and(5.96±1.91),the differences were statistically significant(t values were 2.57-3.98,all P<0.05);the levels of serum total protein and albumin were(54.45±10.58),(33.72±7.19)and(55.19±9.82),(34.00±6.52)g/L in the intermediate degree group and advanced degree group,higher than in the primary degree group and control group(49.11±7.71),(29.61±6.21)and(48.04±8.40),(30.04±6.13)g/L,the differences were statistically significant(t values were 2.19-2.88,all P<0.05).After three and six months of therapy,the scores of PFS-R were(3.41±0.57),(4.62±0.73)in the intermediate degree group,lower than in the primary degree group,advanced degree group and control group(4.25±0.89),(5.43±0.69),(4.19±0.79),(6.11±0.93)and(4.14±0.59),(5.39±0.79)(t values were 4.01-8.63,all P<0.05).Conclusions 7500-9999 steps/d are optimal walking exercise intensity,it can effectively improve the nutritional status and reduce fatigue of patients with esophageal cancer during concurrent chemoradiotherapy.