作者：陈莉莉1，陈蕾2，王云2，葛方红2，徐燕飞3，许容芳4

Authors: Chen Lili1, Chen Lei2, Wang Yun2, Ge Fanghong2, Xu Yanfei3, Xu Rongfang4

Unit:  1.Ambulatory Ward, Nantong Cancer Hospital Southern Hospital, Nantong 226361, Jiangsu, China；  2.Department of Chest Radiotherapy, Nantong Cancer Hospital, Nantong 226361, Jiangsu, China；  3.Department of Internal Medicine, Nantong Cancer Hospital, Nantong 226361, Jiangsu, China；  4.Department of Nursing, Nantong Cancer Hospital, Nantong 226361, Jiangsu, China

摘要：

目的  探讨基于营养风险筛查2002（nutritional risk screening 2002, NRS2002）评分的综合性营养管理在食管癌和胃癌患者放化疗期间的应用。方法  选取南通市肿瘤医院于2020年1月至2023年1月收治的食管癌及胃癌放化疗患者86例，依据随机数字表法分为观察组43例与对照组43例。对照组患者实施常规护理干预，观察组在常规护理干预基础上结合基于NRS2002评分的综合性营养管理。两组干预时间由放化疗开始至放化疗结束。比较两组患者干预前后的心理状况、自我管理能力、营养指标和生存质量变化，以及患者的营养状况。结果  两组患者干预后焦虑自评量表（self-rating anxiety scale, SAS）和抑郁自评量表（self-rating depression scale, SDS）评分低于干预前（P＜0.05）；观察组患者干预后SAS评分和SDS评分低于对照组（P＜0.05）。两组患者干预后自我管理能力测定量表（the rating scale of health self-management skill for adults, AHSMSRS）评分高于干预前（P＜0.05）；观察组患者干预后AHSMSRS评分高于对照组（P＜0.05）。对照组患者干预后血红蛋白（hemoglobin, Hb）、白蛋白（albumin, ALB）和前白蛋白（prealbumin, PA）水平低于干预前（P＜0.05）；观察组患者干预后Hb、ALB和PA水平较干预前无明显变化（P＞0.05）；观察组患者干预后Hb、ALB和PA水平高于对照组（P＜0.05）。观察组患者营养状况良好率高于对照组（P＜0.05）。两组患者干预后躯体健康能力、癌症造成的负担、社会关系健康和心理健康评分高于干预前（P＜0.05）；观察组患者干预后躯体健康能力、癌症造成的负担、社会关系健康和心理健康评分高于对照组（P＜0.05）。结论  基于NRS2002评分的综合性营养管理在食管癌及胃癌患者放化疗期间的应用效果良好，可显著改善患者心理状况和营养状况，提高患者自我管理能力，以及提高患者生存质量。

关键词： 营养风险筛查；综合性营养管理；食管癌；胃癌；放化疗

Abstract：

Objective  To explore the application of comprehensive nutritional management based on nutritional risk screening 2002 (NRS2002) score in esophageal and gastric cancer patients during radiotherapy and chemotherapy. Method  86 esophageal and gastric cancer patients treated with radiotherapy and chemotherapy in our hospital from January 2020 to January 2023 were selected, and divided into an observation group of 43 cases and a control group of 43 cases, according to the random number table method. The control group received routine nursing intervention, while the observation group received comprehensive nutrition management based on NRS2002 score on top of routine nursing intervention. The intervention time of two groups was from the beginning of radiotherapy and chemotherapy to the end. The psychological status, self-management ability, nutritional indicators, quality of life changes, and nutritional status of two groups were compared before and after intervention. Result  After intervention, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores of two groups were lower than before (P<0.05), while the SAS and SDS scores of observation group were lower than those of control group (P<0.05). After intervention, the rating scale of health self-management skill for adults (AHSMSRS) score of two groups was higher than before (P<0.05), while the AHSMSRS score of observation group was higher than that of control group (P<0.05). After intervention, the levels of hemoglobin (Hb), albumin (ALB) and prealbumin (PA) of two groups were lower than before (P<0.05), while the levels of Hb, ALB and PA of observation group showed no significant changes compared with those before intervention (P>0.05); and the levels of Hb, ALB and PA of observation group were higher than those of control group (P<0.05).Therateofgoodnutritionalstatusofobservationgroupwashigherthanthatofcontrol group (P<0.05). After intervention, the physical health ability, burden caused by cancer, social relationship health, and mental health scores of two groups were higher than before (P<0.05); while the physical health ability, burden caused by cancer, social relationship health, and mental health scores of observation group were higher than those of control group (P<0.05). Conclusion  The application of comprehensive nutritional management based on NRS2002 score in esophageal and gastric cancer patients during radiotherapy and chemotherapy has a good effect, which can significantly improve their psychological and nutritional status, enhance their self-management ability, and improve the quality of live.

Key Words:  Nutritional risk screening; Comprehensive nutritional management; Esophageal cancer; Gastric cancer; Radiochemotherapy