基于自评-主观全面评定量表的营养管理在胰腺癌化疗患者中的应用效果分析

Application of nutrition management based on Patient-Generated Subjective Global Assessment in patients with pancreatic cancer undergoing chemotherapy

目的探讨基于自评-主观全面评定量表(PG-SGA)的营养管理对胰腺癌化疗患者营养指标、生命质量等指标的影响,为胰腺癌化疗患者干预方案的实施提供指导。方法采用随机对照试验方法,以便利抽样法选取2021年1月至2022年12月上海长征医院和复旦大学附属肿瘤医院收治的胰腺癌化疗患者96例,按照随机数字表法分为观察组和对照组各48例。对照组予以常规护理方案干预,观察组予以基于PG-SGA的营养管理方案干预。2组均持续干预至出院。比较2组患者干预前后的营养指标、生命质量、癌因性疲乏、睡眠质量与心理状态评分等指标。结果2组最终各纳入48例。对照组男28例,女20例,年龄(63.33±4.31)岁;观察组男27例,女21例,年龄(63.15±4.25)岁。观察组患者干预后的PG-SGA评分、血清三酰甘油水平及疲乏修订自评量表、阿森斯失眠量表、焦虑自评量表、抑郁自评量表评分分别为(3.87±1.16)分、(1.35±0.52)mmol/L、(3.79±0.67)分、(5.31±2.05)分、(44.55±5.14)分、(45.15±5.08)分,均低于对照组的(5.77±1.58)分、(2.04±0.35)mmol/L、(4.82±0.88)分、(7.29±2.14)分、(51.74±5.18)分、(52.26±5.11)分,差异均有统计学意义(t值为4.63~7.63,均P<0.05);血清视黄醇结合蛋白及转铁蛋白水平分别为(18.13±2.41)mg/L、(61.25±5.34)ng/L,均高于对照组的(15.29±2.33)mg/L、(48.31±5.28)ng/L,差异均有统计学意义(t=5.87、11.94,均P<0.05)。观察组患者干预后的症状维度评分(56.17±5.25)分,低于对照组的(66.22±5.57)分,认知、社会、情绪、角色、躯体维度评分分别为(76.35±5.71)、(77.55±6.51)、(75.87±6.45)、(77.38±6.61)、(75.75±6.37)分,均高于对照组的(66.29±5.39)、(65.74±6.34)、(64.22±6.18)、(66.56±6.26)、(65.74±6.11)分,差异均有统计学意义(t值为7.86~9.10,均P<0.05)。结论基于PG-SGA的营养管理应用于胰腺癌化疗患者可降低患者癌因性疲乏程度,缓解负面情绪,改善整体营养状态,提升干预依从性,减少并发症的发生,提高睡眠质量、生命质量及患者满意度。

Objective To explore the effects of nutrition management based on Patient-Generated Subjective Global Assessment(PG-SGA)on nutritional idicators,quality of life and other indicators in patients with pancreatic cancer undergoing chemotherapy,to provide guidance for the implementation of the intervention plan for pancreatic cancer patients undergoing chemotherapy.MethodsThis was a randomized controlled study.From January 2021 to December 2022,96 patients with pancreatic cancer who received chemotherapy in Shanghai Changzheng Hospital and Affiliated Cancer Hospital of Fudan University were selected using convenience sampling method and divided into the observation group and the control group according to the random number table,with 48 cases in each group.The control group was given routine nursing intervention,and the observation group was given PG-SGA-based nutrition management intervention.Patients in both groups continued the intervention until discharge.Nutritional indexes,quality of life,the score of cancer-related fatigue,sleep quality and mental state before and after intervention,intervention compliance and satisfaction after intervention,and complications during intervention of both groups were compared.ResultsThere were 48 patients in each group ultimately.In the control group,there were 28 males,20 females,aged(63.33±4.31)years old;in the observation group,there were 27 males,21 females,aged(63.15±4.25)years old.After intervention,the PG-SGA score,serum triacylglycerol level,and scores of Revised Piper′s Fatigue Scale and Arsens Insomnia Scale,Self-rating Anxiety Scale and Self-rating Depression Scale in the observation group were(3.87±1.16)points,(1.35±0.52)mmol/L,(3.79±0.67)points,and(5.31±2.05),(44.55±5.14),(45.15±5.08)points respectively,lower than the control group′s(5.77±1.58)points,(2.04±0.35)mmol/L,(4.82±0.88)points,and(7.29±2.14),(51.74±5.18),(52.26±5.11)points,the differences were statistically significant(t values were 4.63-7.63,all P<0.05);the serum levels of retinol binding protein and transferrin were(18.13±2.41)mg/L and(61.25±5.34)ng/L,respectively,higher than the control group′s(15.29±2.33)mg/L and(48.31±5.28)ng/L,with statistical significance(t=5.87,11.94,both P<0.05).The symptom domain score in the observation group after intervention was(56.17±5.25)points,lower than(66.22±5.57)points in the control group,while the cognitive,social,emotional,role,and physical scores were(76.35±5.71),(77.55±6.51),(75.87±6.45),(77.38±6.61),(75.75±6.37)points,higher than(66.29±5.39),(65.74±6.34),(64.22±6.18),(66.56±6.26),(65.74±6.11)points in the control group(t values were 7.86 to 9.10,all P<0.05).ConclusionsNutritional management based on PG-SGA could reduce the degree of cancer-induced fatigue,relieve negative emotions,improve the overall nutritional status,improve intervention compliance,reduce the occurrence of complications;improve sleep quality,quality of life,and patient′s satisfaction.