運用營養照護長期追蹤口腔癌病人營養狀況之個案報告

Long-Term Follow-Up of Nutritional Management in A Patient With Oral Cancer-A Case Report

林珈汶(Chia-Wen Lin)

《臺灣膳食營養學雜誌》 11卷2期 (2019/12) Pp. 37-47

https://doi.org/10.6709/TJD.201912_11(2).0004

摘要

口腔癌病人常因反覆復發、手術及同步化學放射治療（concurrent chemoradiotherapy, CCRT）副作用等而造成營養不良。本研究之個案為臺灣南部某醫學中心頰黏膜惡性腫瘤男性病人，2005年即被診斷，2016年再度入院開刀，出院後追蹤至2018年，過程歷經CCRT、下頜骨缺損重建、清創、補皮瓣、高壓氧等。2016年營養介入前，病人在家實際攝取總熱量約1200 kcal/day、蛋白質60g/day、醣類165 g/day、脂肪30 g/day，建議熱量為2100 kcal/day、蛋白質120 g/day、醣類275 g/day、脂肪73 g/day。經詢問飲食歷史後，其營養診斷為吞嚥困難（problem, P），主要原因是進食吞嚥疼痛（etiology, E），且進食時間延長，導致可選擇食物少，熱量僅達建議量57%，蛋白質達建議量50%，醣類為60%，脂肪為41%（signs/symptoms, S）。經營養衛教及追蹤後，病人可選擇適合的食物種類及改善進食量，另腸胃問題及血液生化值均有改善。於2016～2018年的照護期間，病人住院期間接受營養照護紀錄共51次，出院後病人主動平均2週來營養科回診一次，體重從原本的61 kg提高並維持在65 kg，熱量攝取維持在2300 kcal/day以上，行為改變階段則從沉思期進展至行動期。綜合以上，病人住院期間，營養師不間斷地進行營養評估及照護，及回隊照護，促進病人願意配合營養師及醫療團隊等的建議，而能隨病情變化適當調整熱量及高蛋白的餐食內容，有利於傷口癒合及營養狀態之改善。此類個案照護經驗結果值得肯定的是，口腔癌病人及早給予持續性營養照護追蹤之重要性。

關鍵字

口腔癌 ； 營養不良 ； 營養診斷 ； 吞嚥困難

並列摘要

Oral cancer patients are often accompanied with malnutrition due to frequent recurrence, surgery, and the side effects of concurrent chemoradiotherapy (CCRT). The case of this study was a male patient with buccal mucosa malignant tumor in a medical center of southern Taiwan. The diagnosis of patient was confirmed in 2005, re-admitted in 2016, and was followed up until 2018 after discharge. During the period, the patient underwent CCRT, mandibular defect reconstruction, debridement, free flap, hyperbaric oxygen, etc. Before the nutritional intervention in 2016, the intakes of patients at home were 1200 kcal/day, 60 g/day protein, 165 g/day carbohydrate, and 30 g/day lipid, respectively, while the recommended dietary intakes (RDAs) of the patient should be 2100 kcal/day, 120 g/day protein, 275 g/day carbohydrate, and 73 g/day lipid. According to dietary history, his nutritional problem (P) was diagnosed to swallowing difficulty, etiology (E) was pain while swallowing and eating difficulty, which prolonged the eating time, and limited the food intake. The calorie of the patient before the intervention was only 57% of RDA, while the protein, carbohydrate and lipid intakes were 50%, 60% and 41% of RDAs, respectively (signs/symptoms, S). After nutritional education and follow up, the patient could choose appropriate food and increased food intake, and gastrointestinal problems and blood biochemical parameters were improved. During 2016-2018, the patient received 51 times of nutritional care during hospitalization and visited the nutritional clinical department every 2 weeks after discharge. The body weight was patient improved from the 61 kg to 65 kg and calorie intake was maintained ≥ 2300 kcal/day. Behavior change phase of this patient changed from the contemplation to action. In conclusion, continuously nutritional assessment and care by dietitian during hospitalization, and being cared by various medical teams actively, facilitate the willingness of patient to cooperate with the dietitian and medical team, leading to improved calorie and protein intake according to the situation of disease. Continuous care also appears to be to promote wound healing and improved nutritional status. The nutritional care experiences of these cases confirm the importance of continuously early nutritional follow-up for oral cancer patients.

並列關鍵字

oral cancer ； malnutrition ； nutritional diagnosis ； swallowing difficulty