食道癌病人的症狀困擾與營養狀況之相關性研究

目的：探討食道癌病人之症狀困擾與營養狀況之相關性及其影響因素。方法：採橫斷性研究設計，以立意取樣選取南部某區域醫院170位食道癌病人為研究對象，收案期間自2012年4月至2017年7月。研究工具包括「護理營養篩檢表，NNRST」、「症狀困擾量表」及個人特質與醫療相關變項。NNRST 之總分5分，當總分為0-1，則無營養不良風險，總分大於2分則顯示目前有營養不良的風險，需要適當的營養介入。結果：62.4%食道癌病人在接受治療後之進食量明顯減少，52.9%病人僅進食液體食物，且有54.1%病人沒有食慾，38.8%病人因疼痛導致影響進食。食道癌病人營養不良風險之盛行率為60%(102/170)，症狀困擾之平均分數23.9分(SD= 6.1)，營養不良風險與症狀困擾間呈顯著正相關(r=.36, p<.001)。逐步迴歸分析顯示營養不良風險(12.8%)、合併手術和化療(5.1%)、宗教儀式之採用(4.5%)、婚姻狀況(3.1%)、性別(2.5%)等五個因子為食道癌病人症狀困擾之預測因子，可解釋變異量為28.0%。結論/實務運用：本研究結果確認食道癌病人存在著營養不良之高風險，且其營養不良風險與症狀困擾存在著正相關，且為其症狀困擾的重要預測因子。臨床照護上針對食道癌病人，需更深入評估其營養不良之風險，並適當的給予營養衛教或介入及協助，改善病患在治療後之營養不良狀況。

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並列摘要

Objective: This study was examined the symptoms distress and the nutritional status and related factors in patients with esophagus cancer after treatment. Methods: Using a cross-sectional design, 170 patients who were diagnosed esophagus cancer, and recruited from a general hospital in southern Taiwan. Data was collected from April, 2012 to June, 2017 by face to face interview using a self - reported structured questionnaires. Outcome measurements included the Nursing nutritional risk screening tool (NNRST), symptoms distress scale, personal characteristics, and medical related variables. Results: 62.4% esophagus cancer patients reported the amount of intake was decreased, 52.9% patients ate liquid foods only, 54.1% patients no appetite, and 38.8% eating was influenced by pain. The prevalence of malnutrition was 60% (102/170) in esophagus cancer patients. The mean score of symptom distress was 23.9 (SD=6.1). There was a significantly positive correlation between the mean score of NNRST and symptom distress. In the stepwise regression model, two factors were the predictors of nutritional status, included symptom distress (13%) and marital status (3%), and account for 16.0% total variance. Conclusions and clinical applications: This study confirmed the high risk of malnutrition in esophagus cancer patients after treatment. The malnutrition risk is positive correlated with patients’ symptom distress. Health care professionals are responsible to aware patients’ symptom distress and assess the risk of malnutrition, and provide appropriate nutritional intervention to decrease the malnutrition status of esophagus cancer patients after treatment.