营养风险筛查和主观整体评估在胃肠肿瘤病人围手术期中的应用及临床意义

目的:比较营养风险筛查2002(NRS 2002)和病人主观整体评估(PG-SGA)在外科胃肠肿瘤病人中应用的适应性,观察营养风险和营养不良对其临床结局的影响。方法:采用连续定点抽样入组方法,对符合条件的外科胃肠肿瘤病人,在入院48 h内分别采用两种工具进行营养风险筛查和营养评估,并测量记录最近时点的客观营养指标,记录住院时间等结局指标。分析两种筛查评估工具的结果差异及可能原因,比较不同营养评价方法间和与客观营养指标和临床结局的相关性。结果:共有183例手术治疗的病人入组,病人营养风险和营养不良的发生率分别为29.5%和57.9%。NRS 2002与年龄、体重、BMI、上臂肌围(MAMC)和体重下降均存在显著相关性(P<0.01);与诊断、手术方式和身高存在相关性(P<0.05)。PG-SGA与诊断、体重、BMI、MAMC和体重下降存在明显相关性(P<0.01);与年龄、身高、手术方式存在相关趋势(P=0.053,0.054,0.082)。NRS 2002与PG-SGA评分存在明显的相关性(r=0.685,P<0.01)。NRS 2002评分≥3分组与<3分组的年龄、身高、体重、BMI和MAMC间有显著性差异(P<0.05)。PG-SGA评价A、B、C三组间的年龄、体重和BMI等分值差异显著(P<0.05)。结论:NRS 2002和PG-SGA在外科手术胃肠肿瘤病人中具有高相关性和适用性,营养风险筛查优先使用NRS 2002,结合使用PG-SGA避免遗漏。

胃肠肿瘤病人术前健康教育需求调查

目的:了解病人对手术相关知识的需求,以便在健康教育中采取更为有效的教育方式。方法:自行设计调查统计表格,以病人的一般资料、术前健康教育内容的需求、健康教育形式和方法的需求为内容,以询问并代为填写和病人自行填写的形式完成调查。结果:胃肠肿瘤病人对术前健康教育的内容、形式、方法的需求是多样性的。其中94%的病人有面对面交流的需求,93%需要个别指导,63%需要健康教育手册,40%需要DVD等影像资料。结论:护理人员必须不断提高健康教育能力,满足病人对术前相关知识的需求。

胃肠道肿瘤病人术前辅助检查健康宣教新模式的探讨

[目的]提高病人对辅助检查的程序、目的、意义、注意事项的认知度,确保病人更好的配合术前各项辅助检查。[方法]设两组,观察组由专人采取表格化文字方式和面授方式对病人进行各项与疾病相关辅助检查的时间、目的、意义、注意事项、程序、地点等健康宣教、讲解,检查日由专人送病人去各辅助科进行检查;对照组由护士只向病人说明检查的时间、地点,口头告知相关程序,检查日由专人送病人去各辅助科进行检查。[结果]观察组病人对辅助检查的认知情况明显高于对照组。[结论]指导并说明辅助检查的程序目的、意义、注意事项,由专人送病人去各辅助科进行检查,可提高病人对各项与疾病相关辅助检查的认知,增进医护患之间的关系,促进整体护理的进一步完善。

快速康复外科护理在老年胃肠肿瘤患者围手术期间的应用效果分析

对于老年胃肠道肿瘤病人围术期的护理,实施快速康复外科护理的临床应用价值。方法:选取2020-2021年我院80例老年胃肠道肿瘤病人,根据手术先后顺序均分为观察(40例)与对照(40例)两组,常规护理施于对照组,快速康复外科护理施于观察组,对比分析两种护理模式下病人的护理满意程度以及各项手术指标。结果:各项手术指标与术后并发症概率比较,观察组均优于对照组,护理满意程度比较,观察组高于对照组,组间数据比较结果存在统计学价值(P<0.05)。结论:对于老年胃肠道癌症患者,进生快速康复护理的意义在于提高患者的手术指标,缓解患者的心理不良情绪,减轻患者的心理压力,使患者对医疗服务更加满意,值得临床推广。

Postoperative sequential chemotherapy and radiotherapy for locally advanced gastric cancer

Objective The aim of the study was to evaluate the role of postoperative sequential chemotherapy and radiotherapy in patients with locally advanced gastric cancer.Methods From January 2003 to December 2010, 146 gastric cancer patients at our institution(Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China) received postoperative sequential chemotherapy and radiotherapy after radical surgery. Radiotherapy was administered as a dose of 4500 cGy in 25 fractions. For patients with positive margins, the dose was raised to 5040 cGy in 28 fractions. Three cycles of m FOLFOX or PF(cisplatin, 5-fluorouracil) chemotherapy regimen were applied before and after radiotherapy. Three-and 5-year survival rates were analyzed; any adverse effects with respect to hematology, hepatic and renal function, or the gastrointestinal tract that occurred during the treatment were evaluated.Results This cohort consisted of non-metastatic patients: 104 men and 42 women with a median age of 51.0 years. The full course of sequential chemotherapy and radiotherapy(4500–5040 cGy) was completed by 129 patients(88.4%). Seventeen regional relapses(9.8%) and 46 distant relapses(23.8%) were recorded. Fifty patients(34.2%) died during follow-up. The 3-and 5-year overall survival rates(OS) were 60% and 54%, and disease-free survival rates(DFS) were 53% and 47%, respectively. There were no significant differences in survival rate with respect to age, sex, histopathology, N stage, site of the tumor, or margin status. Multivariate analysis showed that only the depth of tumor invasion(T stage) was an independent prognostic factor for OS(P = 0.009) and DFS(P = 0.006). The rates of grades 3 and 4 neutropenia and vomiting were 9.6% and 3.4%, respectively, during the treatment.Conclusion Postoperative sequential chemotherapy with an m FOLFOX or PF regimen and radiotherapy were found to be an effective means of treating advanced gastric cancer patients with T3–T4 disease. The adverse effects of this treatment were tolerable.