胰腺恶性肿瘤患者围手术期全程化营养管理方案应用效果评价

Effect of a Whole-course Nutritional Management Plan for Patients with Pancreatic Malignant Tumors in Perioperative Period

目的 探讨基于循证方法构建的胰腺恶性肿瘤患者围手术期全程化营养管理方案的应用效果。方法 采用方便抽样法选取2023年4-8月于上海市某三级甲等医院胰腺外科接受手术治疗的胰腺恶性肿瘤患者58例,采用随机数字表法将其分为对照组(n=30)和观察组(n=28)。对照组患者接受常规恶性肿瘤营养护理,观察组患者接受基于循证及专家函询构建的营养管理方案。比较两组患者在出院时及出院1个月时的BMI、血清白蛋白、血清前白蛋白、血红蛋白、血糖值等指标,以及营养风险筛查量表(NRS-2002)、患者自评主观全面评定量表(PG-SGA)及生活质量(EORTCQLQ-C30)评分。结果 出院时,观察组患者的PG-SGA得分及BMI值均优于对照组(P<0.05);出院1个月时,观察组患者的NRS-2002与PG-SGA得分及BMI值亦优于对照组,差异具有统计学意义(P<0.05)。出院时及出院1个月后,两组患者总体健康、疲倦、躯体功能、疼痛及失眠5个方面的生活质量评分均高于干预前(P<0.05)。出院时,观察组患者疲倦与总体健康领域得分均优于对照组,差异具有统计学意义(P<0.05);出院1个月时,观察组患者在躯体功能、恶心呕吐、食欲丧失、疲倦与总体健康领域方面得分优于对照组,差异具有统计学意义(P<0.05)。结论 基于循证方法构建的胰腺恶性肿瘤患者围手术期全程化营养管理方案可以有效改善患者术后1个月内的营养状况,同时可以在一定程度上改善患者术后1个月内的生活质量,具有较好的临床实用价值。

Objective To explore the effect of an evidence-based whole-course nutritional management plan for patients with pancreatic malignant tumors in the perioperative period.Methods A total of 58 patients with pancreatic malignant tumors were selected by convenience sampling who received surgical treatment in the Pancreatic Surgery Department of a Grade Ⅲ-A hospital in Shanghai from April to August 2023.They were divided into the control group(n=30) and the observation group(n=28) using a random number table.The control group was given routine nutritional care for malignant tumors,while the observation group was given evidence-based expert-guided nutrition management.Body mass index(BMI),serum albumin,serum prealbumin,hemoglobin,blood glucose and the scores of Nutrition Risk Screening 2002(NRS-2002),PatientGenerated Subjective Global Assessment(PG-SGA) and EORTC QLG Core Questionnaire(EORTCQLQ-C30) were compared between the two groups at discharge and 1 month after discharge.Results At discharge,the PGSGA scores and BMI values in the observation group were superior to those in the control group(P<0.05);1 month after discharge,the NRS-2002 and PG-SGA scores and BMI values in the observation group were also superior to those in the control group,with significant differences(P<0.05).At discharge and 1 month after discharge,the scores of quality of life across 5 dimensions(general health,fatigue,physical function,pain and insomnia) increased in both groups than those before intervention(P<0.05).At discharge,the scores of fatigue and general health in the observation group were superior to those in the control group,with significant differences(P<0.05);1 month after discharge,the scores of physical function,nausea and vomiting,loss of appetite,fatigue and general health in the observation group were superior to those in the control group,with significant differences(P<0.05).Conclusion The evidence-based whole-course nutritional management plan for patients with pancreatic malignant tumors in the perioperative period can significantly enhance the nutritional status of patients within 1 months after surgery and somewhat improve the quality of life of patients within 1 month after surgery,demonstrating substantial clinical practical value.