飲食衛教方案對口腔癌術後病人營養狀況、體重與生活品質之成效

目的：口腔癌治療以手術為主，除了疾病本身，手術治療所導致口腔或顏面結構缺損都是影響病人食物攝取的問題，衝擊層面包括口腔基本功能如說話、吞嚥或咀嚼困難，進而影響營養狀況和生活品質。研究目的是（1）了解口腔癌術後病人營養狀況、體重變化與生活品質之情形。（2）檢視飲食衛教方案介入對口腔癌術後病人營養狀況、體重變化與生活品質之成效。方法：採用類實驗性研究，以口腔癌手術後病人為研究對象。病人於手術後住院期間可經口喝水時即收案，採隨機分組為實驗組42人與對照組42人。實驗組收案時進行第一次營養評估，前測和飲食衛教、運動指導，飲食衛教為每週連續二天共計兩週，收案滿第四週、第八週和第十二週以24小時飲食紀錄法行飲食評估及飲食衛教。對照組收案時進行前測和運動指導。兩組於收案後分別於第四週、第八週和第十二週進行後測，測量變項包括基本資料、疾病與治療相關變項、口腔健康衝擊量表中文版本，護理營養篩檢量表。結果：由概化估計方程模式顯示，實驗組飲食衛教方案介入對病人營養篩檢平均分數比前測減少1.34分，生活品質平均分數比前測減少13.36分，兩者研究結果皆呈現顯著效果（p<.001）。在體重部份雖無顯著增重效果，相較於對照組為負值數結果，實驗組呈現正向增加效果，顯示具有幫助維持體重或減緩病人嚴重體重流失造成健康負面影響。結論：本研究確認飲食衛教方案對口腔癌病人術後營養狀況與生活品質改善之成效，建議抗癌治療期間提供個別性營養支持，才能達到良好的營養狀態及提升生活品質。

關鍵字

口腔癌；營養狀況；飲食衛教方案；生活品質

並列摘要

Objective: Surgery is the mainstay treatment for oral cancer. In addition to the disease, the surgery affects food intake will cause oral or facial structural defects and affect basic oral functions and result in difficulties in speech, swallowing, or mastication, thereby affecting nutrition status and quality of life. This study were to: (1) understand the nutritional status, weight changes, and quality of life in oral cancer patients underwent surgery and (2) examine the effect of diet education program on nutritional status, weight changes, and quality of life in oral cancer patients underwent surgery. Methods: This study employed an experimental design with patients who underwent oral cancer surgery as study subjects. Patients were enrolled immediately when they could sip water after surgery and during hospitalization. The patients were randomized into the experimental group (n=42) and control group (n=42). During enrollment, subjects in the experimental group underwent their first nutritional assessment, pre-testing and dietary health education, and exercise guidance. Dietary health education was carried out for 2 continuous days per week for 2 weeks. At Weeks 4, 8, and 12 after enrollment, 24-hour dietary records were used for dietary assessment and dietary health education. For the control group, pre-testing, and exercise guidance were carried out during enrollment. Post-testing was carried out in both groups at Weeks 4, 8, and 12 after enrollment. The test items included general information, disease and treatment-related variables, the Chinese version of Oral Health Impact Profile (OHIP-14T), and nursing nutritional risk screening tool (NNRST). Results: This study were presented using generalized estimating equations (GEE) and showed that the average scores for nutritional screening and quality of life in the experimental group after diet education program decreased by 1.34 and 13.36 points, respectively as compared with before, and these results were statistically significant (p<.001). Although there was no significant increase in weight, the experimental group showed positive results in comparison to the significant negative results in the control group. This result were helps to maintain weight or can alleviate negative health effects due to severe weight loss in patients. Conclusion and clinical applications: We suggest that personalized nutritional support should be provided during cancer treatment to achieve good nutritional status and quality of life.