灌食訓練計畫對食道癌病患營養狀態之成效探討

Effectiveness of (Tube-feeding) Nutrition Training Program for Esophageal Cancer Patients

10.6880/TJON.201903/SP_19.04

高玉鳳(Yu-Feng Kao)；鄭惠蘭(Hui-Lan Cheng)；李淑慧(Shu-Hui Lee)

灌食訓練 ； 食道癌 ； 空腸造口術 ； Tube Feeding Training ； Esophageal Cancer ； Jejunostomy

腫瘤護理雜誌

19卷增訂刊（2019 / 03 / 01）

39 - 52

繁體中文

食道癌病患的營養狀況與治療成效有關，在接受誘導性同步化學及放射線治療期間，是營養下降的關鍵期，若能在此關鍵期維持或提升病人的營養狀況，就能增加病患對治療耐受度，本研究目的為探討灌食訓練計畫對食道癌接受空腸造口術病患營養狀態之成效探討。本研究採類實驗研究設計，以病患基本屬性資料表、體位測量法、病患主觀性整體營養評估量表、傾倒症候群量表等結構式問卷進行資料收集。收集實驗組及對照組各30名病患，平均年齡55 ± 7歲。生理指標：入院第7天與第14天之身高、體重、身體質量指數無統計上差異、進一步分析術後第7天與第14天與入院時比較兩組下降變化量達統計上差異（p ＜ 0.001）；腸胃道症狀方面：傾倒症候群（DSRS）量表達統計上差異（p ＜ 0.001），顯示實驗組困擾程度低於對照組。在營養方面：整體營養評估總分：實驗組（8.0 ± 2.6）低於對照組（9.7 ± 4.1, p=0.059），顯示對照組病患營養不良程度有較高趨勢。研究結果顯示藉由低速度且漸進式的連續性灌食之腸道灌食訓練計畫介入，可增加病患營養攝取、體重減輕狀況趨緩、降低空腸造口術後因灌食致腸胃道症狀發生率等問題。

The nutritional status of patients with esophageal cancer is associated with treatment outcome. The earlier the nutritional assessment and nutritional intervention are initiated, the more likely it is to avoid the exacerbation of nutritional status. The period of induction concurrent chemotherapy and radiotherapy is the critical point of decline in nutritional status. If the nutritional status of patients can be maintained or improved during this critical time, their tolerability to treatment can be increased and the occurrence of postoperative infection rate and complications can be decreased. The purpose of this study is to investigate the effectiveness of tube feeding training program on the nutritional status of patients with esophageal cancer undergoing jejunostomy. This study adopted quasi-experimental research design and used structured questionnaires, including the patient basic attribute information sheet, body frame measurement, patient's self-completed subjective overall nutritional assessment scale, and dumping syndrome to collect data. This study enrolled 30 patients in the experimental group and 30 patients in the control group. The mean age of patients was 55 ± 7 years old. In terms of physiological indicators, there was no statistical difference in height, weight, and body mass index on post-admission Day 7 and Day 14. However, the further analysis showed that the decline in nutritional status in the two groups between post-operative Day 7 and Day 14 and admission reached statistical significance (p ＜ 0.001). In terms of gastrointestinal symptoms, the difference in Dumping Syndrome Rating reached statistical significance (p ＜ 0.001), suggesting that the level of distress of the experimental group was lower than that of the control group. In terms of nutritional status, patients' total score of overall nutritional assessment in the experimental group (8.0 ± 2.6) was lower than that in the control group (9.7 ± 4.1, p = 0.059), suggesting that the malnutrition of the patients in the control group was higher. The research results showed that the intervention of slow and progressive continuous gastrointestinal tube feeding training program can increase the nutritional intake of patients, alleviate weight loss, and reduce the incidence of gastrointestinal symptoms caused by post-jejunostomy tube feeding.

1. Bauer, J.,Capra, S.(2003).Comparison of a mal-nutrition screening tool with subjective global assessment in hospitalised patients with can-cer—sensitivity and specificity.Asia Pacific Journal of Clinical Nutrition,12(3),257-260.
2. Bower, M. R.,Martin, R. C.(2009).Nutritional management during neoadjuvant therapy for esophageal cancer.Journal of Surgical Oncolo-gy,100(1),82-87.
3. Braga, M.,Gianotti, L.,Gentilini, O.,Liotta, S.,Di Carlo, V.(2002).Feeding the gut early after digestive surgery: Results of a nine-year expe-rience.Clinical Nutrition,21(1),59-65.
4. Buehring, B.,Belavý, D. L.,Michaelis, I.,Gast, U.,Felsenberg, D.,Rittweger, J.(2011).Chang-es in lower extremity muscle function after 6 days of bed rest.Journal of Applied Physiol-ogy,111(1),87-94.
5. Chen, A. M.,Li, B. Q.,Lau, D. H.,Farwell, D. G.,Luu, Q.,Stuart, K.,Vijayakumar, S.(2010).Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradio-therapy for head and neck cancer.International Journal of Radiation Oncology, Biology, Phys-ics,78(4),1026-1032.
6. Heberer, M.,Bodoky, A.,Iwatschenko, P.,Harder, F.(1987).Indications for needle catheter je-junostomy in elective abdominal surgery.The American Journal of Surgery,153(6),545-552.
7. Isenring, E. A.,Bauer, J. D.,Capra, S.(2007).Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves di-etary intake compared with standard practice.Journal of the American Dietetic Association,107(3),404-412.
8. Laurenius, A.,Olbers, T.,Näslund, I.,Karlsson, J.(2013).Dumping syndrome following gastric bypass: Validation of the dumping symptom rating scale.Obesity Surgery,23(6),740-755.
9. Mala, T.,Hewitt, S.,Høgestøl, I. K.,Kjellevold, K.,Kristinsson, J. A.,Risstad, H.(2015).Dump-ing syndrome following gastric surgery. Tidss-krift for den Norske laegeforening: Tidsskrift for raktisk medicin.Ny Raekke,135(2),137-141.
10. Mazaki, T.,Ebisawa, K.(2008).Enteral versus parenteral nutrition after gastrointestinal sur-gery: A systematic review and meta-analysis of randomized controlled trials in the English literature.Journal of Gastrointestinal Surgery,12(4),739-755.
11. McClave, S. A.,Martindale, R. G.,Vanek, V. W.,McCarthy, M.,Roberts, P.,Taylor, B.,Cres-ci, G.(2009).Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN).Journal of Parenteral and Enteral Nutrition,33(3),277-316.
12. Tsottle, N. D.,Piersol Byrnes, H.(2011).Esopha-geal cancer.Cancer nursing: Principles and practice,Sudbury, MA:
13. Valentini, V.,Marazzi, F.,Bossola, M.,Miccichè, F.,Nardone, L.,Balducci, M.,Martorana, G. E.(2012).Nutritional counselling and oral nutri-tional supplements in head and neck cancer pa-tients undergoing chemoradiotherapy.Journal of Human Nutrition & Dietetics,25(3),201-208.
14. 許玉娟, Y. J.,成佳憲, J. C. H.,李章銘, J. M.,陳佳慧, C. C. H.(2014)。食道癌患者的營養改善策略。台灣癌症醫學雜誌，1(1)，3-13。
15. 衛生福利部（2017，6月）．民國106年主要死因分析．取自https://dep.mohw.gov.tw/DOS/lp-1827-113.html

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