惡病質之概念分析

Cachexia: A Concept Analysis

10.6880/TJON.201903/SP_19.02

劉彥廷(Yan-Ting Liou)；孫秀卿(Shiow-Ching Shun)

惡病質 ； 概念分析 ； 評估工具 ； cachexia ； concept analysis ； assessment tool

腫瘤護理雜誌

19卷增訂刊（2019 / 03 / 01）

17 - 26

繁體中文

惡病質是複雜的代謝改變症候群，因過度能量消耗，導致大量骨骼肌與脂肪喪失，而嚴重影響病患的身體功能、生活品質與存活率，由於其導因的複雜性造成臨床照護上相當具有挑戰性，且未被妥善處理；根據文獻指出高達25%的照護人員完全不熟悉惡病質的照護。因此，本文依據Walker and Avant（2011）描述之概念分析步驟，歸納出惡病質六大項定義性特徵：（1）體重下降：六個月內體重下降超過5%；當BMI小於20或肌少症（sarcopenia）病患，六個月內體重下降超過2%者；（2）營養狀態改變；（3）腸胃道症狀；（4）代謝系統失衡；（5）前發炎細胞激素（proinflammatory cytokines）釋放；（6）身體功能下降。比較營養不良、食慾不振與惡病質之定義與特性以釐清惡病質的定義性特徵，並運用典型、邊緣及相反案例說明與分析惡病質概念；同時介紹目前已發展之惡病質評量工具，以提供臨床照護之評估使用。由於護理人員於臨床惡病質照護扮演重要角色，建議護理人員應熟悉惡病質概念並早期發現惡病質病患提供即早之照護措施，進而減緩或遏止惡病質進展，增加治療完成率與存活率，以提升整體臨床照護品質。

Cachexia is a complex metabolic change that results in severe wasting. It is a progressive process leading to excessive energy consumption and extreme loss of skeletal muscle and fat mass. As a result, cachexia severely impacts the physical performance, quality of life, and survival rate in patients. Although it is well known that cachexia significantly influences patients, it is not well-managed in clinical settings. Furthermore, evidence has shown that more than 25% of healthcare providers are not familiar with cachexia management. According to the process of concept analysis in cachexia from Walker and Avant (2011), we created six defining characteristics of cachexia: (1) loss in body weight: weight loss greater than 5% in 6 months, or greater than 2% in individuals with a body mass index of 20 kg/m^2 or sarcopenia, (2) changes in nutritional status, (3) gastrointestinal symptoms, (4) lack of balance in the metabolic system, (5) presence of proinflammatory cytokines, and (6) decrease in physical performance. We compared the characteristics of malnutrition, anorexia, and cachexia in order to clearly define and distinguish the latter. Consequently, the model case, borderline case and contrary case were used to explain and analyze the concept of cachexia. In addition, we introduced several tools developed for clinical settings to assess cachexia. Since nurses play pivotal roles in clinical care, they should be familiar with cachexia and its early detection for the sake of timely intervention. Such efforts could slow or stop the progress of cachexia, which would in turn elevate the completion rate in related treatments and overall survival rate, and thus improve the quality of clinical care.

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