个体化饮食指导对肝癌患者肝动脉灌注化疗栓塞术后营养状况和生活质量的影响

陶敏洁; 雷宇; 金俊; 汤桂芳; 王莉

doi:10.16766/j.cnki.issn.1674-4152.002388

个体化饮食指导对肝癌患者肝动脉灌注化疗栓塞术后营养状况和生活质量的影响

doi: 10.16766/j.cnki.issn.1674-4152.002388

陶敏洁^1, ,,
雷宇¹,
金俊²,
汤桂芳¹,
王莉¹

1.
浙江大学医学院附属杭州市第一人民医院肝胆外科，浙江杭州 310006
2.
杭州西溪医院肿瘤科，浙江杭州 310004

基金项目:

浙江省医药卫生科技计划项目 2020PY015

详细信息

通讯作者:
陶敏洁，E-mail：feishenhaoma@163.com

中图分类号: R735.7 R459.3
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- 文章访问数: 306
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-25
- 网络出版日期: 2022-08-13

Effect of individualised dietary guidance on nutritional status and quality of life of liver cancer patients after TACE

1.
Department of Hepatobiliary Surgery, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的探讨个体化饮食指导对肝癌患者肝动脉灌注化疗栓塞术(TACE)术后营养状况及生活质量的影响。方法选取2019年3月—2020年3月在浙江大学医学院附属杭州市第一人民医院行TACE术后患者120例为研究对象，根据入院先后顺序分为观察组(62例)和对照组(58例)。对照组术后给予常规饮食干预，观察组术后在常规饮食干预基础上给予个体化饮食指导。比较2组术前、术后的营养状况，并评估2组术前和术后的营养风险。结果术后7 d，2组ALB水平均较术前升高(均P＜0.05)；术后3个月，2组ALB水平均较术前和术后7 d明显升高(均P＜0.05)，观察组ALB水平明显高于对照组(P＜0.05)。术后7 d，2组前白蛋白(PALB)均较术前下降(均P＜0.05)，但观察组高于对照组(P＜0.05)；术后3个月，2组PALB水平均较术前和术后7 d明显升高(均P＜0.05)，观察组PALB水平明显高于对照组(P＜0.001)。术后3个月，观察组偏瘦例数少于对照组[8(12.91%) vs. 16(27.59%)，P＜0.05]。术后3个月，观察组存在营养不良发生风险患者明显少于对照组[16(25.81%) vs. 26(44.83%)，χ²=4.766，P=0.029]。术后3个月，观察组EORTC QLQ-C30各生活质量指标评分明显高于对照组(均P＜0.001)。结论个体化饮食指导能有效改善肝癌患者TACE术后的营养状况，降低营养不良发生风险，提高患者的生活质量，值得在临床上推广和使用。
- 肝癌 /
- 肝动脉灌注化疗栓塞术 /
- 个体化营养指导 /
- 营养状况 /
- 生活质量
Abstract: Objective To investigate the effect of individualised diet guidance on nutritional status and quality of life of liver cancer patients after transcatheter arterial chemoembolisation (TACE). Methods Total 120 patients who underwent TACE in Hangzhou first people's Hospital Affiliated to the Medical College of Zhejiang University from March 2019 to March 2020 were selected as the research objects. They were divided into observation group (62 cases) and control group (58 cases) according to the order of admission. The control group was given routine dietary intervention after surgery, and the observation group was given individualised dietary guidance on the basis of routine nutrition after surgery. The preoperative and postoperative nutritional status of the two groups was compared, and their preoperative and postoperative nutritional risk was evaluated. Results On the 7th day after surgery, the ALB level in both groups was higher than that before surgery (all P < 0.05). Three months after operation, the ALB level in both groups was significantly higher than that before operation and 7 days after operation (all P < 0.05), and the ALB level in the observation group was significantly higher than that in the control group (P < 0.05). At 7 days after surgery, PALB indexes in both groups were decreased compared with those before surgery (all P < 0.05), but the observation group had significantly higher indexes than the control group (P < 0.05). Three months after surgery, the PALB level in both groups was significantly higher than that before surgery and 7 days after surgery (all P < 0.05). The PALB level in the observation group was significantly higher than that in the control group (P < 0.001). Three months after operation, the proportion of lean weight in the observation group was significantly lower than that in the control group[8(12.91%) vs. 16(27.59%), P < 0.05]. Three months after operation, the incidence of nutritional risk in the observation group was significantly lower than that in the control group[16(25.81%) vs. 26(44.83%), χ²=4.766, P=0.029]. Three months after operation, the scores of EORTC QLQ-C30 in the observation group were significantly higher than those in the control group (all P < 0.001). Conclusion Individualised dietary guidance can effectively improve the nutritional status of liver cancer patients after TACE, reduce the incidence of malnutrition risk and improve the quality of life of patients, which is worthy of clinical promotion and use.
- Liver cancer /
- Transcatheter arterial chemoembolisation /
- Individualised nutrition guidance /
- Nutritional status /
- Quality of life

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表 1 2组肝癌行肝动脉灌注化疗栓塞术患者手术前后ALB比较(x±s，g/L)

Table 1. Comparison of ALB before and after operation between two groups of hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (x±s, g/L)

组别	例数	术前	术后7 d	术后3个月	F值	P值
观察组	62	33.15±3.15	35.12±3.41^a	38.17±4.62^ab	5.392	＜0.001
对照组	58	33.11±3.17	35.15±3.23^a	35.69±4.29^ab	4.976	＜0.001
t值		0.069	0.132	3.041
P值		0.945	0.895	0.003
注：与同组术前比较，^aP＜0.05；与同组术后7 d比较，^bP＜0.05。

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表 2 2组肝癌行肝动脉灌注化疗栓塞术患者手术前后PALB比较(x±s，mg/d)

Table 2. Comparison of PALB before and after operation between two groups of hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (x±s, mg/d)

组别	例数	术前	术后7 d	术后3个月	F值	P值
观察组	62	18.98±1.03	16.75±0.38^a	24.86±0.67^ab	6.463	＜0.001
对照组	58	18.87±1.09	16.49±0.85^a	21.69±0.58^ab	5.972	＜0.001
t值		0.568	2.187	26.733
P值		0.571	0.031	＜0.001
注：与同组术前比较，^aP＜0.05；与同组术后7 d比较，^bP＜0.05。PALB为前白蛋白。

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表 3 2组肝癌行肝动脉灌注化疗栓塞术患者手术前后营养状态比较[例(%)]

Table 3. Comparison of nutritional status before and after operation between two groups of hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization [caaes (%)]

组别	例数	术前	术后7 d	术后3个月	χ²值	P值
观察组	62	26(41.94)	24(38.71)	8(12.91)^a	3.471	＜0.001
对照组	58	23(39.66)	20(34.48)	16(27.59)^a	3.895	＜0.001
χ²值		0.064	0.231	6.620
P值		0.800	0.631	0.010
注：与同组术前比较，^aP＜0.05。

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表 4 2组肝癌行肝动脉灌注化疗栓塞术患者手术前后EORTC QLQ-C30评分比较(x±s, 分)

Table 4. Comparison of EORTC QLQ-C30 scores before and after operation between two groups of hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (x±s, points)

组别	例数	社会功能		躯体功能		情绪功能
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	62	63.28±4.62	71.86±4.18	26.65±1.78	62.73±4.95	45.22±2.71	53.87±2.75
对照组	58	63.61±4.61	64.82±4.15	26.43±1.65	58.96±4.62	44.95±2.88	46.42±2.62
t值		-0.391	9.252	0.701	4.305	0.529	15.172
P值		0.696	＜0.001	0.485	＜0.001	0.598	＜0.001

组别	例数	心理功能		认知功能		总生活质量
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	62	35.25±2.73	58.85±4.98	29.52±1.57	52.63±2.76	36.92±1.86	61.36±4.97
对照组	58	35.69±2.61	43.49±4.82	29.75±1.43	43.75±2.86	37.17±1.76	46.92±4.81
t值		-0.901	17.148	-0.837	17.307	-0.755	16.154
P值		0.369	＜0.001	0.404	＜0.001	0.452	＜0.001

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