新发急性髓系白血病患者化疗期营养管理

Nutrition management of patients with new acute myeloid leukemia during chemotherapy

目的探讨个性化营养管理在成人初发急性髓系白血病(AML)患者化疗时营养状况的改变,为其营养支持提供依据。方法选取2019年9月至2021年9月在滨州医学院附属医院确诊的AML并使用标准诱导化疗方案的患者125例,用NRS2002对其进行营养风险筛查,NRS2002评分≥3分的患者按照随机抽签法分为干预组和对照组,其中干预组42例、对照组42例。对照组在化疗期间给予常规饮食护理,干预组在化疗期间给予个性化营养管理,均持续一个住院周期。比较两组干预前后能量和营养素的摄入状况,患者主观整体营养评估(PG-SGA)状况以及生活质量的影响。结果两组干预前所有指标比较,差异均无统计学意义(P>0.05)。干预组经过个性化营养管理后,能量、碳水化合物、脂肪以及蛋白质的摄入量高于对照组,动物性蛋白质占比明显提高,植物性蛋白质占比明显降低,差异有统计学意义(P<0.05)。干预组经过个性化营养管理后,PG-SGA的评分低于对照组,差异有统计学意义(P<0.05)。在生活质量评分方面,干预组经过个性化营养管理后,功能领域和总体健康状况领域评分高于对照组,症状领域评分低于对照组,差异有统计学意义(P<0.05)。结论个性化营养管理能有效提高AML患者能量和营养素的摄入,优化蛋白质的构成比,提升患者的营养状况,提高患者的生活质量。

Objective To investigate the changes of nutritional status of adult patients with acute myeloid leukemia(AML)during chemotherapy receiving individualized nutrition management,and to provide the basis for their nutritional support.Methods A total of 125 patients with AML diagnosed in Binzhou Medical University Hospital from September 2019 to September 2021 and treated with standard induction chemotherapy regimen were selected,and they were screened for nutritional risk by NRS2002.Patients with NRS2002 score≥3 points were divided into the intervention group(n=42)and the control group(n=42)according to the random lot drawing method.The control group was treated with conventional diet nursing during chemotherapy,while the intervention group was treated with individualized nutrition management during chemotherapy,both lasting for one hospitalization cycle.The intake of energy and nutrients,the patient-generated subjective global assessment(PG-SGA)and quality of life(QoL)were compared between the two groups before and after the intervention.Results There were no statistically significant differences in all indices between the two groups of patients before intervention(P>0.05).After individualized nutrition management,the intake of energy,carbohydrate,fat and protein in the intervention group was higher than that in the control group,the proportion of animal protein was remarkably increased,and the proportion of vegetable protein was remarkably decreased,with statistically significant differences(P<0.05).After individualized nutrition management,the PG-SGA score of the intervention group was lower than that of the control group,with statistically significant difference(P<0.05).In the QoL score,after individualized nutrition management,the scores of functional areas and general health status in the intervention group were higher than those in the control group,and the scores of symptom areas were lower than those in the control group,with statistically significant differences(P<0.05).Conclusion Individualized nutrition management can effectively increase the intake of energy and nutrients in AML patients,optimize the composition ratio of protein,improve the nutritional status of patients and raise the QoL of patients.