基于互联网大数据食管癌病人围手术期营养支持决策辅助方案的构建和应用

Construction and application of a decision-aid scheme for perioperative nutritional support in patients with esophageal cancer based on internet big data

目的:通过基于互联网大数据的食管癌围手术期营养相关问题和需求的调查,构建食管癌病人围手术期营养支持决策辅助方案,并评价其临床应用效果。方法:采用横断面调查方法,在渥太华决策支持理论框架的指导下,通过文献检索和循证护理的方法拟定食管癌病人围手术期营养支持决策辅助草案,通过2轮专家函询,修订决策辅助内容,制定决策辅助方案的最终版。选取接受食管癌手术的125例病人随机分为对照组(64例)和观察组(61例),对照组接受常规护理及围手术期宣教,观察组在常规护理的基础上接受决策辅助方案。应用自制的营养支持知识水平问卷和营养支持依从性评估表,对病人进行营养支持知识水平和营养支持依从性进行调查和评估。2组病人分别于门诊和术前1 d完成决策困境量表和营养支持知识水平测试问卷;术后1个月和3个月,分别用决策后悔量表进行评估。比较2组病人术前1 d、术后1个月和3个月的营养状况以及营养支持的依从性。结果:观察组术前1 d的决策困境得分较门诊时显著降低(P<0.05);观察组术后1个月和3个月的决策后悔度均显著低于对照组(P<0.05)。观察组在术前1 d的知识水平得分较门诊时显著提高(P<0.05),而对照组差异无统计学意义(P>0.05);观察组的营养支持依从性在术前1 d、术后1个月和3个月均较门诊时显著提高(P<0.05)。术后1个月,观察组前白蛋白和视黄醇结合蛋白显著高于对照组(P<0.05),2组病人转铁蛋白差异无统计学意义(P>0.05);而术后3个月,观察组的前清蛋白、视黄醇结合蛋白和转铁蛋白均显著高于对照组(P<0.05)。结论:本研究制订的营养支持决策辅助方案可有效降低食管癌病人围手术期决策困境水平和决策后悔度,提高病人营养支持相关知识水平和依从性从而改善营养状况。

Objective:To construct and evaluate a decision-aid scheme for nutritional support in patients with esophageal cancer based on the internet big data of the investigation of nutrition-related issues and demands in the perioperative period of esophageal cancer.Methods:Under the guidance of the Ottawa decision support theoretical framework,the draft of decision-aid scheme of perioperative nutritional support for patients with esophageal cancer was drawn up through literature search and evidence-based nursing by using cross section survey method.The draft was revised and the final version of the decision-aid scheme was formulated through two rounds of expert letter consultation.A total of 125 patients were randomly divided into a control group(n=64)and an observation group(n=61).The control group received common nursing and perioperative education,and the observation group received decision-aid scheme besides common nursing.The self-designed nutritional support knowledge level questionnaire and nutritional support compliance assessment scale were used to investigate and evaluate the patients′nutritional support knowledge level and compliance.Results:The decision-making dilemma score of the observation group on the first day before surgery was significantly lower than that of the outpatient department(P<0.05).The decision regret level of the observation group at 1 month and 3 months after surgery was significantly lower than that of the control group(P<0.05).The knowledge level score of the observation group on the first day before surgery was significantly higher than that of the outpatient department(P<0.05),while the difference in the control group was not statistically significant(P>0.05).The nutritional support compliance of the observation group was significantly improved 1 day before surgery,1 month after surgery,and 3 months after surgery compared to the outpatient period(P<0.05).One month after operation,prealbumin and retinol binding protein in the observation group were significantly higher than those in the control group(P<0.05),and there was no significant difference in transferrin between the two groups(P>0.05).Three months after operation,the prealbumin,retinol binding protein and transferrin in the observation group were significantly higher than those in the control group(P<0.05).Conclusions:The nutritional support decision aid scheme constructed in this study can effectively reduce the decision dilemma level and decision regret of patients with esophageal cancer during the perioperative period,and improve the nutritional status of patients by improving their nutritional support-related knowledge and compliance.