住院癌症病人營養狀況之探討

Nutritional Status in Hospitalized Cancer Patients

封威蓮(Wei-Lien Feng)

指導教授 ： 賴裕和

臺北醫學大學/護理學院/護理學研究所/碩士(2004年)

摘要

營養不良是癌症病人最常面對的問題之ㄧ，然而國人目前鮮少對此此課題深入探究。本橫斷式研究旨在探討台北某醫學中心三所腫瘤病房住院癌症病人之營養狀況。共收集132位個案，資料內容包括病患基本資料、症狀嚴重程度、身體質量指數（body mass index; BMI）、身體功能狀態（Karnofsky performance status; KPS）及營養篩檢-迷你營養評估（Mini-Nutritional Assessment; MNA）。其中30位個案進一步收錄72小時飲食攝取訪談記錄。資料分析以描述性統計、單因子變異數分析（one way ANOVA）、事後檢定（Scheffe’s post hoc）、皮爾森相關（Pearson’s correlation）、多元逐步回歸（multiple stepwise regression）。研究結果發現：（1）MNA總分平均值為（±SD）17.37±4.76；超過一半的個案（n=67, 50.8%）被歸類為潛在性營養不良及53例病患（40.2%）為營養不良。（2）72小時飲食攝取資料分析顯示總熱量低於一般健康人，特別是脂肪的攝取最為偏低；以及（3）逐步迴歸分析指出整體症狀嚴重程度、BMI、KPS評分、血紅素值、頭頸癌/食道癌及腸胃道惡性腫瘤的診斷能顯著預測以MNA 總分作為評估的營養狀況（R2＝69.9 %）。本研究結果提出癌症病患的營養仍然是個需要努力的課題。為改善癌症病患營養狀況，本研究建議對此問題及其相關因素應投注更多的關懷。 關鍵詞：營養、癌症、症狀、身體功能狀態（KPS）、迷你營養評估（MNA）

關鍵字

營養 ； 癌症 ； 症狀 ； 身體功能狀態 ； KPS ； 迷你營養評估 ； MNA

並列摘要

Malnutrition is one of the most common problems faced by cancer patients, yet few studies have explored this problem. The purposes of this cross-sectional study were to investigate the nutritional status of hospitalized cancer patients in three inpatient oncology wards at a medical center in Taipei. Data collected on 132 subjects included background and disease-related information, symptom severity, Body Mass Index (BMI), performance status (by Karnofsky Performance Status, KPS) and nutritional screening (by Mini-Nutritional Assessment, MNA). Thirty of these subjects were further interviewed about their 72-hour dietary intake. Data were analyzed by descriptive statistics, one-way ANOVA, Scheffe’s post-hoc test, Pearson’s correlation, and multiple stepwise regression. The results showed that: (1) the mean (±SD) MNA score was 17.37±4.74; more than half the subjects (n=67, 50.8%) were categorized as “at nutritional risk” and 53 (40.2%) were identified as “malnourished”; (2) analysis of the 72-hour dietary intake data showed that total caloric intake was less than that of normal healthy people, especially for fat intake; and (3) stepwise multiple regression analysis indicated that overall symptom severity, BMI, KPS scores, hemoglobin, diagnosis with head and neck cancers and GI cancers significantly predicted nutritional status as assessed by MNA scores (R2 =69.9%). These results suggest that the nutrition of cancer patients is still a problem. To improve cancer patients’ nutritional status, the authors recommend that more attention be devoted to this issue and its related factors.

並列關鍵字

Nutrition ； Cancer ； Symptom ； Karnofsky performance status (KPS) ； Mini-Nutritional Assessment (MNA )

參考文獻

周繡玲(2000)?癌症病人營養問題與照顧需求?安寧療護雜誌，5(4)，50-60。

林佳靜、陳淑如、謝麗鳳(1987)?疼痛護理?護理雜誌，44(1)，37-47。

邱艷芬(1995)?重症期間之代謝變化及改變?護理雜誌，42(2)，7-10。

劉桂芬(1999)?肺癌病患症狀困擾與功能狀態之相關性探討?未發表的碩士論文，國立陽明大學，台北。 劉慧玲、邱艷芬(1997)?開心手術病人手術前後營養狀況與手術後預後相關性之探討?護理研究，5(3)，267-278。

戰臨茜(2000)?老年人營養狀況狀與醫療服務利用之關係?未發表的碩士論文，國防醫學大學，台北。 謝明哲、胡淼琳、楊素卿、陳俊榮、徐成金、陳明汝(2000)?實用營養學?台北:匯華。 簡怡雯、黃美智、廖芳瑄、陳佳君、謝明哲(2003)?住院病人營養評估新模式之建立?中華民國營養學會雜誌，28(4)，200-209。