胰腺癌术后患者居家营养管理的应用研究

Study on the Application of Home Nutrition Management for Patients with Pancreatic Cancer after Operation

摘要: 目的：对胰腺癌术后患者进行居家营养管理方案干预研究，探讨该方案对出院后患者营养状况、营养不良风险及生存质量的干预效果。方法：选取2021年7月至2022年6月在青岛大学附属医院肝胆胰外科行胰十二指肠切除术的100例胰腺癌患者为研究对象，随机分为对照组和干预组各50人，对照组患者出院前后予以常规健康宣教，干预组在常规健康宣教的同时实施胰腺癌术后患者居家营养管理方案，干预时间3个月，使用营养风险筛查2002 (NRS2002)和癌症患者生命质量测定量表(EORTCQLQ-C30)，评价该方案对胰腺癌术后患者出院后营养状况、营养不良风险及生存质量的干预情况。结果：出院前两组患者体重和BMI水平相当，差异无显著统计学意义(P > 0.05)；出院后1个月干预组体重(57.75 ± 5.42 kg)高于对照组体重(56.12 ± 6.13 kg)，但差异无显著统计学意义(P = 0.106)；干预组BMI (19.88 ± 0.67)高于对照组BMI (19.44 ± 0.70)，差异有显著统计学意义(P < 0.05)；出院后3个月，干预组与对照组患者体重(57.23 ± 6.60 kg)和BMI (19.82 ± 0.87)相比，其中干预组患者体重(60.00 ± 5.56 kg)和BMI (20.65 ± 0.75)均显著高于对照组，且均有统计学差异(P < 0.05)。出院前两组患者白蛋白水平相当，无显著统计学差异(P > 0.05)；出院后1个月和出院后3个月，与对照组患者白蛋白水平(37.63 ± 1.19 g/L, 37.47 ± 1.18 g/L)相比，干预组患者白蛋白水平更高(39.10 ± 1.43 g/L, 40.00 ± 1.12 g/L)，且均具有显著统计学差异(P < 0.05)。出院时两组患者NRS 2002 < 3的患者频数相当(P > 0.05)；出院后1个月和出院后3个月，尽管干预组患者NRS 2002 < 3的患者(n = 29, 58%; n = 36, 72%)多于对照组(n = 26, 52%; n = 29, 58%)，但无显著统计学差异(P > 0.05)。居家营养管理改善患者生存质量。使用EORTCQLQ-C30对评价患者出院后生存质量进行系统评价，结果显示，干预组患者在接受居家营养管理方案后，其身体、角色、情绪、认知以及社会功能方面的得分均显著高于对照组(P < 0.05)，综合评价后干预组患者的总健康状态明显优于对照组(P < 0.05)。结论：本研究构建的胰腺癌术后患者居家营养管理方案，通过给予胰腺癌术后患者科学、具体及个性化的居家营养管理策略，提高了患者出院后居家健康状况，降低了患者营养不良风险，同时提高了患者居家生活质量。

Abstract: Objective: To investigate the intervention effect of home nutrition management program on nutri-tional status, malnutrition risk and quality of life in patients with pancreatic cancer after surgery. Methods: A total of 100 patients with pancreatic cancer who underwent pancreaticoduodenectomy in the Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao Uni-versity from July 2021 to June 2022 were selected as the research objects. They were randomly di-vided into the control group and the intervention group, with 50 patients in each group. The inter-vention group was given routine health education and home nutrition management program for pancreatic cancer patients after surgery for 3 months, and the intervention time was 3 months. The Nutritional risk screening 2002 (NRS2002) and the Quality of Life Questionnaire for cancer patients (EORTCQLQ-C30) were used, to evaluate the intervention effect of the program on nutritional status, malnutrition risk and quality of life in patients with pancreatic cancer after discharge. Results: There was no significant difference in body weight and BMI between the two groups before dis-charge (P > 0.05). One month after discharge, the body weight of the intervention group (57.75 ± 5.42 kg) was higher than that of the control group (56.12 ± 6.13 kg), but the difference was not sta-tistically significant (P = 0.106). The BMI of the intervention group (19.88 ± 0.67) was higher than that of the control group (19.44 ± 0.70), and the difference was statistically significant (P < 0.05). Three months after discharge, the body weight (60.00 ± 5.56 kg) and BMI (20.65 ± 0.75) of the in-tervention group were significantly higher than those of the control group (57.23 ± 6.60 kg and 19.82 ± 0.87). And the differences were statistically significant (P < 0.05). There was no significant difference in albumin level between the two groups before discharge (P > 0.05). One month and three months after discharge, compared with the control group (37.63 ± 1.19 g/L, 37.47 ± 1.18 g/L), the albumin level of the intervention group was higher (39.10 ± 1.43 g/L, 40.00 ± 1.12 g/L). The differences were statistically significant (P < 0.05). There was no significant difference in the fre-quency of patients with NRS 2002 < 3 at discharge between the two groups (P > 0.05). Although pa-tients in the intervention group with NRS 2002 < 3 (n = 29, 58%; n = 36, 72%) were more than those in the control group (n = 26, 52%; n = 29, 58%), there was no significant difference (P > 0.05). Home nutrition management can improve the quality of life of patients. EORTCQLQ-C30 was used to systematically evaluate the quality of life of patients after discharge. The results showed that the scores of body, role, emotion, cognition and social function in the intervention group were signifi-cantly higher than those in the control group after receiving home nutrition management program (P < 0.05). After comprehensive evaluation, the total health status of the intervention group was significantly better than that of the control group (P < 0.05). Conclusions: The home nutrition man-agement program constructed in this study can improve the home health status of patients after discharge, reduce the risk of malnutrition, and improve the patients by providing scientific, specific and personalized home nutrition management strategies for patients with pancreatic cancer after operation.