提升接受積極治療的頭頸癌病人營養介入成效

A Study on the Effectiveness of Nutritional Intervention in a Head and Neck Cancer Patient

蔡慧君(Hui-chun Tsai) ； 林淑雯(Shu-wen Lin) ； 郭集慶(Victor C. Kok) ； 王銘志(Ming-Chih Wang) ； 賴仁淙(Jen-Tsung Lai) ； 阮祺文(Chi-Wen Juan)

《弘光學報》 79期 (2017/03) Pp. 47-60

https://doi.org/10.6615/HAR.201703.79.04

摘要

研究目的：頭頸癌病人因疾病分期或者治療中產生副作用等因素以導致進食量減少、體重流失以及營養不良等臨床問題，且分析本院各癌別營養介入成效發現頭頸癌介入後體重流失最多。本研究探討台中光田綜合醫院頭頸癌病人經營養介入及團隊照護其營養成效分析。研究方法：回溯性分析2014-2015年病人資料進行介入成效比較，營養師以24小時飲食回憶法收集飲食史，主觀資料及客觀資料如體重變化、營養生化指標如白血球、嗜中性白血球及血紅素等，並進行病人營養認知測驗等分析營養介入成效。結果：2015年頭頸癌18位個案，平均年齡52.7±6.12歲，平均體重61.6±11.1kg，介入期間平均體重流失2.01±5.3 kg(流失比例3.3%)，較2014年減少3.3%比例的平均體重流失。介入前熱量攝取1290±732 kcal/day，介入後為1609±402 kcal/day，達成熱量建議人數比率與2014年相比增加11%(從72%增加至83%)。蛋白質介入前攝取46.1±28.4 g/day，介入後63.9±17.0 g/day達統計上顯著差異 (p＜0.05)，且達建議量人數比率增加26%(從63%增加至89%)。病人營養認知方面發現病人對於如何選擇高蛋白質食物較不清楚 (無法清楚說出富含高蛋白食物，肉魚豆蛋奶類)，經營養師介入後，前測成績平均為61.2分，衛教後增加至97.0分達顯著差異 (p＜0.05)。結論：營養衛教有助於病人增加攝食量，進而改善體重流失情形，以及提升病人營養知識，改善營養相關生化值利於維持良好營養狀態。

關鍵字

營養介入 ； 頭頸癌 ； 營養認知 ； 營養不良

並列摘要

Objective: Patients of head and neck cancer due to stage of disease or the treatment of side effects and other factors lead to a reduction in food intake, weight loss and malnutrition and other clinical problems. In our hospital, we found after nutrition intervention that head and neck cancer lost more weight than the other cancer. Therefore we investigated nutritional intervention and nutritional care team on the head and neck cancer patients. Methods: Retrospective analysis on 2014-2015 years of nutritional interventional patient data. Our nutritionists collected diet history by 24-hour dietary recall, the subjective and objective data and information, such as weight change, nutritional and biochemical data, such as white blood cells, absolute neutrophil count (ANC), and hemoglobin and other factors. And patient's nutritional intervention cognitive tests, to know our nutritional intervention effect. Results: A total 18 cases of head and neck cancer on 2015, the mean age were 52.7± 6.12 years and the average weight were 61.6 ± 11.1kg, the mean body weight loss during the intervention were 2.01 ± 5.3 kg (weight loss ratio 3.3%). we decreased 3.3% average weight loss compared with 2014. Before intervention, patients calorie intake were 1290 ± 732 kcal / day, after intervention were 1609 ± 402 kcal / day, the patient reach nutritionist's target ratio were increased 11% compared with 2014(increased from 72% to 83%). Protein intake before intervention was 46.1 ± 28.4 g / day, after intervention were 63.9 ± 17.0 g / day and had statistically significant difference. The number of reach nutritionist's target ratio increased to 26% compare with 2014 (increased from 63% to 89%). Nutritional knowledge test of patient that we found how to choose high-protein foods are less clear (can't clearly to say protein-rich foods, ex: meat, fish, beans, eggs and milk class), after nutrition education, the nutrition test score significant higher than pretest score (p ＜0.05) (61.2 points increased to 97.0 points). Conclusion: Nutrition education helps patients increase food intake, avoid weight loss and further improve the situation and enhance patient knowledge of nutrition.

並列關鍵字

nutritional intervention ； head and neck cancer ； nutrition knowledge ； malnutrition

參考文獻

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