頭頸癌病人於同步化學與放射線治療期間鼻胃管放置時間對體重改變之探討

Time of Nasogastric Tube Insertion and Its Relationship to Body Weight Changes– An Assessment in Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

蕭佳欣(Chia-Hsin Hsiao)

指導教授 ： 賴裕和

共同指導教授 ： 孫秀卿 ； 婁培人 ； 王駿瑋(Chun-Wei Wang)

國立臺灣大學/醫學院/護理學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.00376

摘要

頭頸部癌症病人(Head and Neck Cancer, HNC) 於接受同步化學與放射線(Concurrent Chemoradiotherapy , CCRT) 期間，因治療副作用往往導致吞嚥困難，因而影響營養，然而放置鼻胃管，是否會改善此問題，臨床中仍有不同看法；因此，本研究目的為: (1)針對HNC病人於CCRT期間，在營養、身體活動功能、常見治療副作用、症狀嚴重度及鼻胃管認知的變化與有、無置放鼻胃管之關係；(2)探討置放鼻胃管前、後體重及鼻胃管認知的變化；(3)瞭解置放鼻胃管之時間點(第幾週)及持續時間(天數)與體重變化之相關性。本研究採縱貫式研究設計於台北某醫學中心收案，針對HNC病人，自接受CCRT前至治療結束後兩週期間，於十個時間點 (T0~T9)，作每週一次的評估。以體重、身體活動功能、治療副作用(National Cancer Institute Common Toxicity Criteria)及症狀嚴重度每週評估;再以MNA（Mini Nutritional Assessment）與鼻胃管認知於三個時間點，治療前、治療第四週、治療及數當週 (T0、T4、T7) 評估，最後觀察變化探討其關係。本研究共收案50人，包含無置放鼻胃管者34人，置放鼻胃管者16人，以重複測量 (Repeated measures ANOVA)及t-test作統計分析。研究結果顯示: (1)病人之症狀嚴重度及治療副作用大多於治療結束當週最為嚴重；(2)在置放鼻胃管前病人每週平均體重差為(0.85公斤)，較置放鼻胃管後大(0.58公斤)；在控制噁心因素後，置放鼻胃管後更可以減少體重下降幅度，並達顯著差異 (p<0.05)，且病人在置放鼻胃管後對鼻胃管之認同度顯著提昇 (p<0.01)；(3)置放鼻胃管時間越早，體重下降程度越少；置放鼻胃管持續時間(天數)越長者，體重下降程度越少，該趨勢接近統計上顯著呈現負相關。研究結果初步得知HNC病人於CCRT期間之副作用，會造成病人體重下降，且可能導致營養不良，若能較早給予經鼻胃管灌食，可能會減少體重下降，改善營養狀況。未來宜增加個案數，以更加確定本研究結果。

關鍵字

頭頸部癌症 ； 同步化學與放射線治療 ； 鼻胃管 ； 營養 ； 體重 ； 認知

並列摘要

Concurrent chemoradiotherapy (CCRT) is the major treatment for patients with head and neck cancers (HNC) after surgery. Acute oral cavity side effects might decrease patients’ intake, nutrition and body weight. Nasogastric (NG) tube feeding has been recognized as one of the methods to prevent patients’ nutrition problems during CCRT. However, timing and duration of inserting NG tube are not yet been identified for the best nutrition improvement. Therefore, the purposes of this study are to : (1) examine the changes of nutrition, performance, common side effects of CCRT, severity of symptoms, and patients’ perception (cognition) about inserting NG tube (Cognition about Inserting NG) over the period of CCRT; and (2) explore the associations between body weight changes and timing (week) of and duration of inserting NG tube (days) after controlling patients’ nausea severity (from chemotherapy side effects). A prospective longitudinal panel design with 10 times weekly assessments (T0-T9) was conducted to assess HNC patients from pre-treatment to following weeks across CCRT period. Patients were assessed by trained oncology nurse by NCI Toxicity Criteria, symptom severity scale, MNA (Mini Nutritional Assessment), performance status, NG tube cognition assessment scale, and background information form. Institutional Review Board (IRB) approval was obtained before data collection. The results showed: (1) a total of 50 patients were recruited with 16 patients having NG tube insertion during CCRT; (2) Overall, patients reported to have the most serious side effects around the end of CCRT; (3) for those having NG tube, they had less weekly body weight loss (0.58 kg) after inserting NG tube than pre-NG inserting phase (0.85 kg/week) after controlling for nausea factor; (4) patients with NG tube reported to have a more positive identity about inserting NG tube (p <0.01) compared to pre-NG insertion; (5) Inserting NG tube earlier was found to be significantly related to less body weight loss; (6) Therer is a trend of having longer duration (number of days) of inserting NG tube, the less of body weight loss. This finding is close to statistically significant. Results of this study strongly suggest that appropriate health education to support HNC patients about the NG insertion before CCRT may help them to better accept taking NG tube earlier to prevent the severe nutrition deficient and body weight loss. More patients subjects would be strongly to be recruited for better understanding this important clinical phenomena.

並列關鍵字

Head and Neck Cancer ； Concurrent Chemoradiotherapy ； Nasogastric tube ； Nutrition ； Body Weight ； Cognition

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