目的 探讨恶性肿瘤患者伴重度营养不良营养干预依从性对营养状况的影响。 方法 回顾性分析 2019 年 4 月至 2021 年 6 月都江堰市人民医院肿瘤科收治的 506 例恶性肿瘤伴重度营养不良患者,采用营养风险筛查 2002(NRS 2002)、患者 主观整体评估(PG-SGA)、简明膳食自评工具对患者进行筛查评估,采用营养治疗五阶梯原则进行营养诊断、营养治疗、疗效 评价及随访,根据患者对制订营养治疗计划的依从性进行分组(营养治疗开始 2 周后,根据服药依从性量表评估患者依从性, 评分<6 分入依从性差组,评分≥ 6 分入依从性好组),并监测两组患者血常规、白蛋白、前白蛋白、体能、身高、体重等营养指 标。 结果 对 60 岁以下肿瘤患者营养干预 2 周后,在血钾、白蛋白、握力、2 周体重丢失率方面的变化,依从性好的患者优于依 从性差的患者(均 P < 0. 05);对 60 岁及以上肿瘤患者营养干预 2 周后,在红细胞、白蛋白、前白蛋白、C 反应蛋白、握力、2 周 体重丢失率方面的变化,依从性好的患者优于依从性差的患者(均 P < 0. 05)。 依从性好的肿瘤患者体力状况评分[2(2, 3)分] 低于依从性差的患者[3(2, 3)分],膳食评分[3(1, 3)分]高于依从性差的患者[2(1, 3)分]。 体力状况评分< 3 分或≥ 3 分、 膳食评分< 3 分或≥ 3 分的肿瘤患者营养干预 2 周后,在白蛋白、前白蛋白、握力、2 周体重丢失率方面的变化,均为依从性好 的患者优于依从性差的患者(均 P < 0. 05)。 结论 恶性肿瘤伴重度营养不良患者经过规范的营养治疗,依从性好的患者在快 速变化指标如白蛋白和前白蛋白,中速变化指标如握力和 2 周后体重丢失率方面,均得到明显的改善。

Objective To investigate the effect of nutritional intervention compliance on nutritional status and clinical outcome of patients with malignant tumor with severe malnutrition. Method A retrospective analysis was performed on 506 patients with malignant tumor and severe malnutrition admitted to the Department of Oncology from April 2019 to June 2021. The patients were screened and evaluated by nutritional risk screening NRS 2002 tumor nutrition assessment PG-SGA and simple dietary self-assessment tools. Using nutritional treatment principle of five steps to nutrition diagnosis treatment and curative effect evaluation and follow - up nutrition therapy plan according to the patient􀆳s compliance to group 2 weeks after treatment with nutrition to assess patients compliance score < 6 points into poor compliance group scoring six points into the good compliance group or higher Blood routine albumin prealbumin physical fitness height weight and other nutritional indicators were monitored in 2 groups. Result After nutritional intervention for tumor patients under 60 years old for two weeks the changes of blood potassium albumin grip strength and weight loss rate in two weeks were better in patients with good compliance than those with poor compliance all P < 0. 05 . The changes of RBC albumin prealbumin CRP grip strength and twoweek weight loss rate in tumor patients aged 60 years and over after nutritional intervention for two weeks were better in patients with good compliance than in patients with poor compliance all P < 0. 05 . The physical status score of tumor patients with good compliance 2 2 3 was lower than that of tumor patients with poor compliance 3 2 3 and the dietary score 3 1 3 was higher than that of tumor patients with poor compliance 2 1 3 . Patients with PS score < 3 points or ≥ 3 points and dietary score < 3 points or ≥ 3 points had better compliance than those with poor compliance in terms of albumin prealbumin grip strength and weight loss rate within two weeks after nutritional intervention all P < 0. 05 . Conclusion After standardized nutritional therapy patients with malignant tumors with severe malnutrition showed significant improvement in rapid changes such as albumin and prealbumin moderate changes such as grip strength and weight loss rate after 2 weeks in patients with good compliance.