基于患者主观整体评估的精准营养干预在结直肠癌患者护理中的应用

鲍丽超; 贺颖

doi:10.16766/j.cnki.issn.1674-4152.004189

基于患者主观整体评估的精准营养干预在结直肠癌患者护理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004189

鲍丽超^,,
贺颖

湖州师范学院附属第一医院(湖州市第一人民医院)肛肠外科，浙江湖州 313000

基金项目:

浙江省科技厅基础公益研究计划项目 LTGY24H160038

详细信息

通讯作者:
鲍丽超，E-mail：blc7131583@163.com

中图分类号: R473.6 R735.3
计量
- 文章访问数: 3
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-12-26
- 网络出版日期: 2025-11-17

Application of precision nutrition intervention based on patient subjective holistic assessment in nursing care of patients with colorectal cancer

BAO Lichao^,,
HE Ying

Department of Anorectal Surgery, the First Affiliated Hospital of Huzhou Normal University (Huzhou First People ' s Hospital), Huzhou, Zhejiang 313000, China

摘要

摘要: 目的基于患者主观整体评估(PG-SGA)构建结直肠癌精准营养干预方案，为该类患者营养管理提供参考。方法选取2022年3月—2024年3月于湖州市第一人民医院治疗的101例结直肠癌患者，采用随机数字表法分为对照组(n=50)和观察组(n=51)，对照组采用常规营养干预，观察组采用基于PG-SGA的精准营养干预，对比2组营养状况、免疫功能、化疗期间胃肠道不良反应发生率及欧洲癌症研究与治疗组织生命质量测定量表(EORTCQLQ-C30)评分。结果观察组干预后BMI、上臂围与对照组比较差异无统计学意义(P＞0.05)；总蛋白[(63.44±7.22)g/L vs.(52.09±6.73)g/L]、白蛋白[(35.77±6.73)g/L vs.(30.12±5.25)g/L]及血红蛋白[(110.98±11.23)g/L vs.(95.45±5.67)g/L]水平均高于对照组(P＜0.05)；CD3⁺[(71.22±8.94)% vs.(60.09±7.85)%]、CD4⁺[(47.80±6.32)% vs.(39.09±5.66)%]及CD4⁺/CD8⁺(1.70±0.45 vs.1.49±0.37)均高于对照组(P＜0.05)；胃肠道不良反应总发生率低于对照组(P＜0.05)；EORTCQLQ-C30各维度评分高于对照组(P＜0.05)。结论基于PG-SGA的精准营养干预可提升结直肠癌患者营养状态，改善免疫功能，减轻化疗不良反应，提高生活质量。
- 结直肠癌 /
- 患者主观评估 /
- 精准营养 /
- 营养状况 /
- 免疫功能
Abstract: Objective To construct a precision nutrition intervention program for colorectal cancer based on patient-generated subjective global assessment (PG-SGA), and to provide a reference for the nutritional management of similar patients. Methods A total of 101 patients with colorectal cancer who were treated in Huzhou First People ' s Hospital from March 2022 to March 2024 were selected and divided into a control group (n=50) and an observation group (n=51) by random number table method. The control group received conventional nutrition intervention, while the observation group received PG-SGA-based precision nutrition intervention. Nutritional status, immune function, incidence of gastrointestinal adverse reactions during chemotherapy, and the score of the European organization research and therapeutic tissue quality of life scale (EORTCQLQ-C30) were compared between the two groups. Results There was no significant difference in BMI and upper arm circumference between the observation group and the control group after intervention (P>0.05). The levels of total protein [(63.44±7.22) g/L vs. (52.09±6.73) g/L], albumin [(35.77±6.73) g/L vs. (30.12±5.25) g/L] and hemoglobin [(110.98±11.23) g/L vs. (95.45±5.67) g/L] were higher than those of control group (P < 0.05); CD3⁺ [(71.22±8.94) % vs. (60.09±7.85) %], CD4⁺ [(47.80±6.32) % vs. (39.09±5.66) %] and CD4⁺/CD8⁺(1.70±0.45 vs. 1.49±0.37) were higher than those in the control group (P < 0.05). The total incidence of gastrointestinal adverse reactions was lower than that of the control group (P < 0.05). The scores of EORTCQLQ-C30 were higher than those of the control group (P < 0.05). Conclusion Precise nutritional intervention based on PG-SGA can improve the nutritional status of colorectal cancer patients, improve immune function, reduce the adverse reactions of chemotherapy, and improve the quality of life.
- Colorectal cancer /
- Patient subjective assessment /
- Precision nutrition /
- Nutritional status /
- Immune function

HTML全文

表 1 2组结直肠癌患者一般资料比较

Table 1. Comparison of general data of colorectal cancer patients between the two groups

项目	对照组(n=50)	观察组(n=51)	统计量	P值
性别(例)			0.476^a	0.490
男性	24	21
女性	26	30
年龄(x±s，岁)	45.23±6.77	45.40±7.01	0.124^b	0.902
BMI(x±s)	19.98±3.17	19.74±3.49	0.362^b	0.719
文化程度(例)			0.571^a	0.752
初中及以下	14	11
高中或中专	23	26
大学及以上	13	14
婚姻状况(例)			1.745^a	0.186
已婚	38	44
未婚/离异/丧偶	12	7
疾病部位(例)			0.338^a	0.561
结肠	36	34
直肠	14	17
肿瘤分期(例)			0.978^c	0.451
Ⅰ期	6	7
Ⅱ期	33	35
Ⅲ期	11	9
注：^a为χ²值，^b为t值，^c为Z值。

下载: 导出CSV

表 2 2组结直肠癌患者干预前后营养指标比较(x±s)

Table 2. Comparison of nutritional indexes of colorectal cancer patients between the two groups(x±s)

组别	例数	BMI		上臂围(cm)		总蛋白(g/L)		白蛋白(g/L)		血红蛋白(g/L)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	19.98±3.17	20.09±4.11	24.66±4.50	24.80±5.91	43.56±5.12	52.09±6.73^b	24.68±3.22	30.12±5.25^b	75.66±5.71	95.45±5.67^b
观察组	51	19.84±3.49	20.19±3.57	24.70±5.12	24.89±5.13	43.78±6.77	63.44±7.22^b	24.77±4.09	35.77±6.73^b	75.70±6.89	110.98±11.23^b
统计量		0.362^a	1.981^c	0.042^a	1.770^c	0.184^a	15.671^c	0.123^a	11.231^c	0.032^a	16.567^c
P值		0.719	0.341	0.967	0.351	0.854	＜0.001	0.903	＜0.001	0.975	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 3 2组结直肠癌患者干预前后免疫功能指标比较(x±s)

Table 3. Comparison of immune function indexes between the two groups of colorectal cancer patients(x±s)

组别	例数	CD3⁺(%)		CD4⁺(%)		CD4⁺/CD8⁺
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	46.77±5.67	60.09±7.85^b	31.67±4.59	39.09±5.66^b	1.04±0.21	1.49±0.37^b
观察组	51	46.80±6.21	71.22±8.94^b	31.77±5.71	47.80±6.32^b	1.01±0.27	1.70±0.45^b
统计量		0.025^a	14.654^c	0.097^a	19.431^c	0.622^a	13.092^c
P值		0.980	＜0.001	0.923	＜0.001	0.535	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 4 2组结直肠癌患者胃肠道不良反应发生情况比较

Table 4. Comparison of gastrointestinal adverse reactions in colorectal cancer patients between the two groups

组别	例数	恶心(例)	呕吐(例)	厌食(例)	腹泻(例)	便秘(例)	合计[例(%)]
对照组	50	9	6	4	2	2	23(46.00)
观察组	51	5	2	4	1	1	13(25.49)
注：2组不良反应总发生率比较，χ²=4.630，P=0.031。

下载: 导出CSV

表 5 2组结直肠癌患者干预前后EORTCQLQ-C30评分比较(x±s，分)

Table 5. Comparison of EORTCQLQ-C30 scores between the two groups of colorectal cancer patients (x±s, points)

组别	例数	躯体功能		情绪功能		社会功能		认知功能		角色功能
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	56.78±5.67	60.97±7.31^b	60.54±7.12	68.34±6.32^b	60.21±7.23	65.21±6.44^b	59.07±8.23	64.55±9.21^b	61.23±8.90	68.77±8.94^b
观察组	51	56.88±6.89	69.45±8.22^b	60.78±8.45	79.23±7.41^b	60.45±8.21	77.23±8.24^b	59.15±6.14	73.56±10.24^b	61.56±9.24	74.12±7.04^b
统计量		0.080^a	15.671^c	0.154^a	20.981^c	0.156^a	22.341^c	0.055^a	17.897^c	0.183^a	24.566^c
P值		0.937	＜0.001	0.878	＜0.001	0.877	＜0.001	0.956	＜0.001	0.855	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(16)

[1]	CHONMAITREE P, SUDCHAROEN A, POONYAM P, et al. Comparison of Patient-Generated Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA) for nutritional assessment in hepatocellular carcinoma patients[J]. Support Care Cancer, 2025, 33(2): 116.
[2]	FUCHS-TARLOVSKY V, VELASCO GIMENO C, ARIAS-SOBERÓN M D, et al. Translation, cultural adaptation, and assessment of the linguistic and content validity of the PG-SGA to the Spanish linguistic setting by cancer patients and healthcare professionals[J]. Nutrition, 2024, 128(11): 112567. DOI: 10.1016/j.nut.2024.112567.
[3]	余文娟, 郑红建, 余双娟, 等. 脑卒中后吞咽障碍患者PG-SGA评分与不良预后风险的相关性[J]. 中华全科医学, 2024, 22(4): 586-588, 681. doi: 10.16766/j.cnki.issn.1674-4152.003456 YU W J, ZHENG H J, YU S J, et al. Association between PG-SGA scores and the risk of poor outcomes in stroke patients with dysphagia[J]. Chinese Journal of General Practice, 2024, 22(4): 586-588, 681. doi: 10.16766/j.cnki.issn.1674-4152.003456
[4]	刘晓妹, 陈文秀, 孙甜甜. 基于PG-SGA评估的针对性膳食管理对胃癌术后化疗患者的影响[J]. 护理实践与研究, 2022, 19(22): 3428-3433. LIU X M, CHEN W X, SUN T T. Effect of targeted dietary management based on PG-SGA assessment on postoperative chemotherapy patients with gastric cancer[J]. Nursing Practice and Research, 2022, 19(22): 3428-3433.
[5]	赵建兰, 王瑞景, 程慧. 基于自评-主观全面量表的个体化营养干预对妇科肿瘤术后化疗患者营养状态及免疫功能的影响[J]. 癌症进展, 2023, 21(2): 169-172. ZHAO J L, WANG R J, CHENG H. Effect of patient-generated subjective global assessment based individualized nutritional intervention on nutritional status and immune function of patients with gynecological tumors undergoing postoperative chemotherapy[J]. Oncology Progress, 2023, 21(2): 169-172.
[6]	洪洁. 基于患者主观整体评估的多学科团队管理在肺癌患者术后营养管理中的应用[J]. 检验医学与临床, 2022, 19(6): 837-840. HONG J. Application of multidisciplinary team management based on patient subjective holistic assessment in postoperative nutritional management of lung cancer patients[J]. Laboratory Medicine and Clinic, 2022, 19(6): 837-840.
[7]	马月, 吴蓓雯. 癌症患者营养管理指南解读[J]. 上海护理, 2017, 17(2): 10-15. MA Y, WU B W. Interpretation of nutritional management guidelines for cancer patients[J]. Shanghai Nursing, 2017, 17(2): 10-15.
[8]	祝芸, 张淑丹. PG-SGA与NRS2002评估筛查下营养支持方案改良促进老年急性胰腺炎临床预后效果分析[J]. 当代护士(下旬刊), 2022, 29(2): 58-61. ZHU Y, ZHNAG S D. PG-SGA and NRS2002 to evaluate the effect of improved nutritional support under screening to promote clinical prognosis in elderly patients with acute pancreatitis[J]. Modern Nurse, 2022, 29(2): 58-61.
[9]	龚钰, 田婧汝, 陈盼, 等. 脑瘤患者生活质量测定量表EORTCQLQ-C30、QLQ-BN20的中文版评价[J]. 护士进修杂志, 2020, 35(6): 490-494, 500. GONG Y, TIAN J R, CHNE P, et al. Evaluation of the Chinese version of EORTCQLQ-C30, QLQ-BN20 for brain tumor patients[J]. Journal of Nurses Training, 2020, 35(6): 490-494, 500.
[10]	汤权琪, 周美玲, 徐皖湘. PG-SGA联合生物电阻抗相位角分析技术的个性化营养干预在胃癌化疗中的应用[J]. 安徽医学, 2022, 43(7): 804-808. TANG Q Q, ZHOU M L, XU W X. The application of personalized nutritional intervention combining PG-SGA with bioelectrical impedance phase Angle analysis technology in chemotherapy for gastric cancer[J]. Anhui Medical Journal, 2022, 43(7): 804-808.
[11]	张延萍, 何志婷, 张倩. 基于PG-SGA的个体化营养干预对血液透析患者营养状态及磷管理效果的影响[J]. 海南医学, 2023, 34(8): 1174-1178. ZHANG Y P, HE Z T, ZHNAG Q. Effect of individualized nutritional intervention based on PG-SGA on nutritional status and phosphorus management in patients undergoing hemodialysis[J]. Hainan Medical Journal, 2023, 34(8): 1174-1178.
[12]	浦伟青, 王晶晶, 秦娜梅, 等. 基于PG-SGA的个体化营养干预在中晚期食管癌患者术后化疗中的临床应用研究[J]. 国际护理学杂志, 2021, 40(2): 306-309. PU W Q, WANG J J, QIN N M, et al. Clinical application of individualized nutrition intervention based on PG-SGA in postoperative chemotherapy in patients with advanced esophageal cancer[J]. International Journal of Nursing, 2021, 40(2): 306-309.
[13]	王莹, 张凤莲, 苏莹. 基于患者自评-主观全面评定量表的个性化营养干预在胃癌术后化疗患者中的应用效果[J]. 癌症进展, 2024, 22(3): 269-273. WANG Y, ZHANG F L, SU Y. Application effect of personalized nutrition intervention based on patient generated subjective global assessment in patients with gastric cancer undergoing postoperative chemotherapy[J]. Oncology Progress, 2024, 22(3): 269-273.
[14]	陈思芮, 陈英, 吴莉莉, 等. 六种衰弱评估工具对老年结直肠癌患者术后短期不良结局的预测性能比较[J]. 中国临床研究, 2024, 37(2): 236-241. CHEN S R, CHEN Y, WU L L, et al. Comparison of six frailty assessment tools for predicting short-term adverse outcomes in elderly colorectal cancer patients after surgery[J]. Chinese Journal of Clinical Research, 2024, 37(2): 236-241.
[15]	肖霞, 郭轶, 王童, 等. 基于PG-SGA的个性化营养干预方案对结直肠癌患者术后的影响[J]. 贵州医科大学学报, 2022, 47(6): 740-744. XIAO X, GUO Y, WANG T, et al. Effects of PG-SGA personalized nutritional intervention on postoperative care for patients with colorectal cancer[J]. Journal of Guizhou Medical University, 2022, 47(6): 740-744.
[16]	蒋琳, 蒋琼, 苗培培, 等. 精准营养干预对前列腺癌术后化疗患者营养状态、化疗不良反应的影响[J]. 癌症进展, 2024, 22(11): 1247-1251. JIANG L, JIANG Q, MIAO P P, et al. Effects of precision nutrition intervention on nutritional status and adverse reactions of prostate cancer patients undergoing postoperative chemotherapy[J]. Oncology Progress, 2024, 22(11): 1247-1251.